Amended in Senate June 14, 2013

Amended in Senate June 13, 2013

Amended in Senate June 12, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 82


Introduced by Committee on Budget (Blumenfield (Chair), Bloom, Bonilla, Campos, Chesbro, Daly, Dickinson, Gordon, Jones-Sawyer, Mitchell, Mullin, Muratsuchi, Nazarian, Skinner, Stone, and Ting)

January 10, 2013


An act to amend Section 680 of the Business and Professions Code, to amend Sections 6254, 26605.6, 26605.7, and 26605.8 of the Government Code, to amend Sections 1180.6, 1250.2, 1254, 1254.1, 1266.1, 1275.1, 1275.5, 1324.9, 1373, 111792, 123870, 123929, 123940, and 123955 of, and to add Section 104151 to, the Health and Safety Code, to amend Sections 10125, 10127, 12693.70, 12698, 12737, and 12739.61 of the Insurance Code, and to amend Sections 359, 708, 4005.7, 4080, 5150, 5151, 5157, 5202, 5326.9, 5358, 5366.1, 5404, 5405, 5585.21, 5585.50, 5585.55, 5675, 5675.1, 5675.2, 5751.7, 5768, 5840, 5845, 5846, 5909, 6007, 6551, 7100, 14105.22, 14105.3, 14131.10, 14134, 14707.5, and 15911 of, to add Sectionsbegin insert 14005.275,end insert 14100.3, 14100.51, 14100.52, 14132.86, and 14132.89 to, to add Part 3.3 (commencing with Section 15800) to Division 9 of, to add and repeal Section 14005.281 of, and to repeal Section 14131.07 of, the Welfare and Institutions Code, relating to health, and making an appropriation therefor, to take effect immediately, bill related to the budget.

LEGISLATIVE COUNSEL’S DIGEST

AB 82, as amended, Committee on Budget. Health.

(1) Existing law authorizes a sheriff to release a prisoner from a county correctional facility for transfer to a medical care facility or residential care facility upon the advice of a physician, as specified, or if the sheriff determines that the prisoner would not reasonably pose a threat to public safety and the prisoner, upon diagnosis by the examining physician, is deemed to have a life expectancy of 6 months or less, provided the sheriff gives specified notice to the superior court. Existing law also authorizes the sheriff to request the court to grant medical probation or to resentence a prisoner to medical probation in lieu of jail time if the prisoner is physically incapacitated with a medical condition that renders the prisoner permanently unable to perform activities of basic daily living, which has resulted in the prisoner requiring 24-hour care, and if that incapacitation did not exist at the time of sentencing or if the prisoner would require acute long-term inpatient rehabilitation services. Existing law requires a county that chooses to implement these provisions to pay the nonfederal share of a prisoner’s or probationer’s Medi-Cal costs for the period that the individual would have otherwise been incarcerated or been on medical probation. Existing law requires a county board of supervisors to adopt a process to fund the nonfederal share of Medi-Cal costs, as specified, before implementing the above-referenced provisions and to notify the State Department of Health Care Services of the process.

This bill would revise the conditions under which a county may implement these release or medical probation provisions by requiring the county to notify the department when a released prisoner has applied for Medi-Cal or is returned to custody and to also pay the nonfederal share of certain nonreimbursable medical costs paid by the state, and state administrative costs, as specified. The bill would specify the Legislature’s intent that implementation of these provisions would not result in increased costs to the General Fund and should not jeopardize federal financial participation for the Medi-Cal program.

(2) Existing law establishes the Long-Term Care Quality Assurance Fund in the State Treasury and requires, beginning August 1, 2013, all revenues received by the State Department of Health Care Services categorized by the department as long-term quality assurance fees, including specified fees on certain intermediate care facilities and skilled nursing facilities, as specified, to be deposited into the fund. Existing law requires the moneys in the fund to be available, upon appropriation by the Legislature, for expenditure by the department to provide supplemental Medi-Cal reimbursement for intermediate care facility services, and to enhance federal financial participation in the Medi-Cal program or to provide additional reimbursement to, and to support facility quality improvement efforts in, licensed skilled nursing facilities.

This bill would authorize the Controller to use the funds in the Long-Term Quality Assurance Fund for cashflow loans to the General Fund, as specified.

(3) Existing law requires the State Department of Health Care Services to provide, no later than January 10 and May 14 of each year, the fiscal committees of the Legislature with an estimate package for the Every Woman Counts Program, as specified.

This bill would instead require that the reporting occur each year no later than January 10 and concurrently with the May Revision of the annual budget. The bill would additionally require that the estimate package include a breakout of costs for specified clinical service activities, policy changes, and fund information.

(4) Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. Among other things, the act establishes the Mental Health Services Oversight and Accountability Commission to oversee the administration of various parts of the Mental Health Services Act, and requires that the commission administer its operations separate and apart from the State Department of Health Care Services. The act provides that the Legislature may clarify procedures and terms of the act by majority vote.

This bill would require that the commission administer its operations separate and apart from the California Health and Human Services Agency. The bill would also make technical changes.

(5) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including specialty mental health services and drug treatment services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

This bill would require the department, by January 10 and concurrently with the May Revision of the annual budget, to provide to the fiscal committees of the Legislature specified fiscal information with respect to the Medi-Cal Specialty Mental Health Services Program and the Drug Medi-Cal Program. The bill also would require the department to post this information on its Internet Web site.

(6) Existing federal law requires the State Department of Health Care Services to describe the Medi-Cal program in a state plan. Under existing state law, the Director of Health Care Services has those powers and duties necessary to conform to requirements for securing approval of the state plan. Existing federal law authorizes the Secretary of Health and Human Services to waive provisions of federal Medicaid law under specified circumstances, including, among others, when the secretary finds that the waiver would be cost effective and efficient. Existing state law requires the department to seek a variety of waivers of federal law, including, among others, to implement objectives that may include better care coordination for seniors, persons with disabilities, and children with special health care needs.

This bill would require the department to post on its Internet Web site all submitted state plan amendments and all federal waiver applications and requests for new waivers, waiver amendments, and waiver renewals and extensions, within 10 business days from the date the department submits these documents for approval to the federal Centers for Medicare and Medicaid Services (CMS). The bill would require the department to also post on its Internet Web site approval or denial letters, or, if applicable, withdrawal notifications, and accompanying documents for all submitted state plan amendments and federal waiver applications and requests within 10 business days from the date the department receives notification of final approval or denial from CMS, or, if applicable, within 10 business days from when the department notifies CMS of the withdrawal. The bill would require the department to post on its Internet Web site all pending submitted state plan amendments and federal waiver requests, as specified, that were submitted in 2009 and every year thereafter unless already posted pursuant to these provisions.

(7) Existing law states the intent of the Legislature that the State Department of Health Care Services develop Medi-Cal reimbursement rates for clinical laboratory or laboratory services in accordance with specified criteria. Existing law exempts from compliance with a specified regulation laboratory providers reimbursed pursuant to any payment reductions implemented pursuant to these provisions for 12 months following the date of implementation of this reduction.

This bill would extend the length of this exemption from 12 months to 21 months. The bill also would extend the date by which laboratory providers are required to submit certain data reports, for the purposes of establishing reimbursement rates, by an additional 5 months. The bill would also make technical changes to those provisions.

(8) Existing law authorizes the State Department of Health Care Services to enter into contracts with providers licensed to dispense dangerous drugs or devices, as specified, to provide specialized care in the distribution of specialized drugs for Medi-Cal beneficiaries. Existing law requires the department, when implementing those provisions, to, among other things, consult current standards of practice when executing a provider contract, contract with a nonexclusive number of providers that meet the needs of the affected population, and generate an annual report, as prescribed. Under existing law, those provisions pertaining to specialized drugs become inoperative 3 years after the date of implementation or July 1, 2013, whichever is earlier.

This bill would delete the provision making those provisions inoperative and would delete the reporting requirement. This bill would also make technical changes to those provisions.

(9) Existing law limits the total number of Medi-Cal physician office and clinic visits to 7 visits per beneficiary per fiscal year, except as specified.

This bill would delete these provisions.

(10) Existing law requires Medi-Cal beneficiaries to make copayments for specified services and, upon federal approval, existing law revises the copayment rates and makes other related changes, as specified.

This bill would provide that these copayment requirements shall not apply to certain preventive services or any approved adult vaccines and their administration, as specified and that these services shall be provided without any cost sharing by the beneficiary.

(11) Existing law requires the State Department of Health Care Services, in collaboration with specified entities, to create a plan for a performance outcomes system for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services provided to eligible Medi-Cal beneficiaries under 21 years of age.

This bill would require the department, by February 1, 2014, to convene a stakeholder advisory committee for purposes, among other things, of developing measures for screening and referring Medi-Cal beneficiaries to mental health services and supports, and to make recommendations regarding performance and outcome measures. The bill would require the department to incorporate into the performance outcomes system these screenings and referrals, and to provide an updated performance outcomes system plan to the fiscal and appropriate policy committees of the Legislature by October 1, 2014. The bill would require the department to propose how to implement the updated performance systems outcome plan by January 10, 2015.

(12) Existing law requires the State Department of Health Care Services, to the extent federal participation is available pursuant to an approved state plan amendment, to extend Medi-Cal benefits to independent foster care adolescents, as defined.

This bill would require, until January 1, 2014, the department, using general fund moneys to the extent federal funds are not available, to maintain Medi-Cal eligibility for all former independent foster care adolescents who, on or after July 1, 2013, but no later than December 31, 2013, lose Medi-Cal coverage as a result of attaining 21 years of age.

(13) Existing law provides for a schedule of benefits under the Medi-Cal program, which includes all of the following: emergency and essential diagnostic and restorative dental services, subject to utilization controls, as specified, certain optional adult dental benefits, and enteral nutrition products subject to the Medi-Cal list of enteral nutrition products and utilization controls. Existing law, except as specified, requires that the purchase of enteral nutrition products be limited to those products administered through a feeding tube.

This bill would, on May 1, 2014, or the effective date of any necessary federal financial participation approvals, whichever is later, provide specified dental services be included as a covered medical benefit for persons 21 years of age or older, subject to utilization controls. The bill, effective May 1, 2014, would also provide that the purchase of prescribed enteral nutrition products is a covered benefit, subject to the Medi-Cal list of enteral nutrition products and utilization controls.

(14) Existing law requires the State Department of Health Care Services, subject to federal approval, to authorize a local Low Income Health Program (LIHP) to provide health care services to eligible low-income individuals under certain circumstances. Existing law requires the department, in consultation with participating entities, as defined, to determine actuarially sound per enrollee capitation rates for LIHPs, as specified, and to pay those rates to the participating entity. Existing law requires that, if the participating entity and the department reach an agreement regarding reimbursement rates, the rate be applied no earlier than the first day of the LIHP year in which the parties agree to the rate. Existing law provides an exception to that provision with respect to the LIHP year ending June 30, 2012.

This bill would delete the above-described exception.

(15) Under existing law, the State Department of Social Services is responsible for the licensing of psychiatric health facilities, as defined, and mental health rehabilitation centers, as described, and the approval of certain 72-hour treatment and evaluation facilities. Existing law requires the State Department of Social Services to adopt regulations necessary to implement those provisions.

This bill would transfer, from the State Department of Social Services, those responsibilities related to licensing and approval of those facilities to the State Department of Health Care Services. The bill would authorize the State Department of Health Care Services to adopt regulations necessary to implement those responsibilities. The bill would make various related, technical, and conforming changes to reflect the transfer of those responsibilities.

(16) Existing law provides the Director of Health Care Services with the authority and responsibility to monitor and approve special treatment programs in skilled nursing facilities.

This bill would require the State Department of Health Care Services to conduct annual certification inspections of special treatment programs for the mentally disordered, as specified.

(17) Existing law requires the manufacturer of any cosmetic product subject to regulation by the federal Food and Drug Administration that is sold in this state to, on a schedule and in electronic or other format, determined as specified, provide a complete and accurate list of specified cosmetic products that, as of the date of submission, are sold in the state and that contain any ingredient that is a chemical identified as causing cancer or reproductive toxicity. Existing law includes, among those chemicals identified, any chemical contained in the product for purposes of fragrance or flavoring, and any chemical identified by the phrase “and other ingredients” and determined to be a trade secret, as specified.

This bill would require the State Department of Public Health, on or before December 31, 2013, to develop and make operational a consumer-friendly, public Internet Web site that creates a database of cosmetic product information collected pursuant to those provisions. The bill would require that the database be searchable to accommodate a wide range of users, including users with limited technical and scientific literacy. The bill would require the Internet Web site to include hypertext links to other educational and informational Internet Web sites to enhance consumer understanding.

(18) Existing law establishes the Access for Infants and Mothers (AIM) Program, administered by the Managed Risk Medical Insurance Board. The board contracts with a variety of health plans and health care delivery systems to provide health insurance coverage to eligible persons who pay a subscriber contribution. An “AIM-linked infant” is defined as any infant born to a woman enrolled in AIM after June 30, 2004, and is eligible for health care coverage under the Healthy Families Program. Existing law establishes the Healthy Families Program administered by the board, and provides that eligible subscribers, except certain AIM-linked infants, be transitioned to the Medi-Cal program, no sooner than January 1, 2013.

begin insert

This bill would require the State Department of Health Care Services to ensure coordination of covered services across all delivery systems of care in order to minimize disruption of services for children transitioning from the Healthy Families Program to Medi-Cal.

end insert
begin delete

This

end delete

begin insertTheend insert bill would terminate eligibility for coverage under the Healthy Families Program for AIM-linked infants, and the board would be required to cease providing health care coverage for those infants on October 1, 2013, or when the State Department of Health Care Services has implemented specified provisions, whichever occurs later. The bill would require the board to coordinate with the State Department of Health Care Services to implement the AIM-Linked Infants Program, which would be created by the bill, including transition of AIM-linked infants to the program. The bill would require the State Department of Health Care Services to administer the AIM-Linked Infants Program, as provided, to address the health care needs of children formerly covered under the Healthy Families Program. The bill would condition the implementation of these provisions on the receipt of federal approvals and the availability of federal financial participation. The bill would also make related and conforming changes.

This bill would also revise the eligibility criteria for the AIM Program by requiring that income be determined, counted, and valued as required under a specified provision of federal law.

(19) Existing law establishes the California Major Risk Medical Insurance Program, which is administered by the Managed Risk Medical Insurance Board, to provide major risk medical coverage to persons who, among other things, have been rejected for coverage by at least one private health plan. Existing law requires the board to establish program contribution amounts for each category of risk for each participating health plan and requires that these amounts be based on the average amount of subsidy funds required for the program as a whole, to be determined in a specified manner. Existing law, for the period commencing January 1, 2013, to December 31, 2013, inclusive, additionally authorizes the program to further subsidize subscriber contributions based on a specified percentage of the standard average individual risk rate for comparable coverage, as specified. Existing law requires the program to pay program contribution amounts to participating health plans from the Major Risk Medical Insurance Fund, a continuously appropriated fund.

This bill would delete the termination date for further subsidization of subscriber contributions. By extending the duration of these subsidies made from a continuously appropriated fund, the bill would make an appropriation.

(20) Existing law requires the Managed Risk Medical Insurance Board to manage a temporary high risk pool to provide health coverage, until January 1, 2014, to specified individuals who have preexisting conditions, consistent with the federal Patient Protection and Affordable Care Act.

This bill would change the termination date to July 1, 2013, except as required by the contract between the board and the United States Department of Health and Human Services, and would no longer require the board to conduct transition activities, as prescribed.

(21) Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the executive board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014. Existing law requires the board to undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling in the Exchange, and requires the board to inform individuals of eligibility requirements for the Medi-Cal program, the Healthy Families Program, or any applicable state or local public program and, if, through screening of the application by the Exchange, the Exchange determines that an individual is eligible for of those programs, to enroll that individual in the program.

This bill would require the State Department of Health Care Services to accept contributions by private foundations in the amount of at least $14,000,000 for purposes of making payments to entities and persons for Medi-Cal in-person enrollment assistance, as specified, and in the amount of at least $12,500,000 to provide allocations for the management and funding of Medi-Cal outreach and enrollment plans, as specified. The bill would require the State Department of Health Care Services to immediately seek an equal amount of federal matching funds. The bill would also provide for the payment of those enrollment assistance payments, as specified.

(22) Existing law requires the State Department of Health Care Services to seek a demonstration project or federal waiver of Medicaid law to implement specified objectives, which may include better care coordination for seniors, persons with disabilities, and children with special health care needs.

This bill would require the department, commencing no later than August 1, 2013, to convene a series of stakeholder meetings to receive input from clients, family members, providers, counties, and representatives of the Legislature concerning the development of the Behavioral Health Services Plan as required by the Special Terms and Conditions of California’s Bridge to Reform Section 1115(a) Medicaid Demonstration.

(23) Existing law provides specified health care coverage to individuals under the AIDS Drug Assistance Program (ADAP) and under federal Ryan White Act funded programs, which are administered by the State Department of Public Health.

This bill would require the State Department of Public Health to report to the Joint Legislative Budget Committee by October 1, 2013, on whether any of the projections or assumptions used to develop the ADAP estimated budget in the Budget Act of 2013 may result in an inability of ADAP to provide services to ADAP eligible clients. If the State Department of Public Health determines, before October 1, 2013, that ADAP is unable to provide services to ADAP eligible clients, the bill would require the department to notify the committee with 15 calendar days of making that determination.

(24) Existing law establishes the Infant Botulism Treatment and Prevention Program and requires the State Department of Public Health to administer this program.

This bill would require the State Department of Public Health, by October 1, 2013, to submit to the fiscal and appropriate policy committees of the Legislature a report describing how it plans to address the findings and recommendations described in a report relating to this program.

(25) This bill would reappropriate the balance of specified funds appropriated in the Budget Act of 2012 to the Department of Managed Health Care until June 30, 2014, to be used as specified, thereby making an appropriation.

(26) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P11   1

SECTION 1.  

Section 680 of the Business and Professions Code
2 is amended to read:

3

680.  

(a) Except as otherwise provided in this section, a health
4care practitioner shall disclose, while working, his or her name
5and practitioner’s license status, as granted by this state, on a name
6tag in at least 18-point type. A health care practitioner in a practice
7or an office, whose license is prominently displayed, may opt to
8not wear a name tag. If a health care practitioner or a licensed
9clinical social worker is working in a psychiatric setting or in a
10setting that is not licensed by the state, the employing entity or
11agency shall have the discretion to make an exception from the
12name tag requirement for individual safety or therapeutic concerns.
13In the interest of public safety and consumer awareness, it shall
14be unlawful for any person to use the title “nurse” in reference to
15himself or herself and in any capacity, except for an individual
16who is a registered nurse or a licensed vocational nurse, or as
17otherwise provided in Section 2800. Nothing in this section shall
18prohibit a certified nurse assistant from using his or her title.

19(b) Facilities licensed by the State Department of Social
20Services, the State Department of Public Health, or the State
21Department of Health Care Services shall develop and implement
22policies to ensure that health care practitioners providing care in
23those facilities are in compliance with subdivision (a). The State
24Department of Social Services, the State Department of Public
25Health, and the State Department of Health Care Services shall
26verify through periodic inspections that the policies required
P12   1pursuant to subdivision (a) have been developed and implemented
2by the respective licensed facilities.

3(c) For purposes of this article, “health care practitioner” means
4any person who engages in acts that are the subject of licensure
5or regulation under this division or under any initiative act referred
6to in this division.

7

SEC. 2.  

Section 6254 of the Government Code is amended to
8read:

9

6254.  

Except as provided in Sections 6254.7 and 6254.13,
10nothing in this chapter shall be construed to require disclosure of
11records that are any of the following:

12(a) Preliminary drafts, notes, or interagency or intra-agency
13memoranda that are not retained by the public agency in the
14ordinary course of business, if the public interest in withholding
15those records clearly outweighs the public interest in disclosure.

16(b) Records pertaining to pending litigation to which the public
17agency is a party, or to claims made pursuant to Division 3.6
18(commencing with Section 810), until the pending litigation or
19claim has been finally adjudicated or otherwise settled.

20(c) Personnel, medical, or similar files, the disclosure of which
21would constitute an unwarranted invasion of personal privacy.

22(d) Contained in or related to any of the following:

23(1) Applications filed with any state agency responsible for the
24regulation or supervision of the issuance of securities or of financial
25institutions, including, but not limited to, banks, savings and loan
26associations, industrial loan companies, credit unions, and
27insurance companies.

28(2) Examination, operating, or condition reports prepared by,
29on behalf of, or for the use of, any state agency referred to in
30paragraph (1).

31(3) Preliminary drafts, notes, or interagency or intra-agency
32communications prepared by, on behalf of, or for the use of, any
33state agency referred to in paragraph (1).

34(4) Information received in confidence by any state agency
35referred to in paragraph (1).

36(e) Geological and geophysical data, plant production data, and
37similar information relating to utility systems development, or
38market or crop reports, that are obtained in confidence from any
39person.

P13   1(f) Records of complaints to, or investigations conducted by,
2or records of intelligence information or security procedures of,
3the office of the Attorney General and the Department of Justice,
4the California Emergency Management Agency, and any state or
5local police agency, or any investigatory or security files compiled
6by any other state or local police agency, or any investigatory or
7security files compiled by any other state or local agency for
8correctional, law enforcement, or licensing purposes. However,
9state and local law enforcement agencies shall disclose the names
10and addresses of persons involved in, or witnesses other than
11confidential informants to, the incident, the description of any
12property involved, the date, time, and location of the incident, all
13diagrams, statements of the parties involved in the incident, the
14statements of all witnesses, other than confidential informants, to
15the victims of an incident, or an authorized representative thereof,
16an insurance carrier against which a claim has been or might be
17made, and any person suffering bodily injury or property damage
18or loss, as the result of the incident caused by arson, burglary, fire,
19 explosion, larceny, robbery, carjacking, vandalism, vehicle theft,
20or a crime as defined by subdivision (b) of Section 13951, unless
21the disclosure would endanger the safety of a witness or other
22person involved in the investigation, or unless disclosure would
23endanger the successful completion of the investigation or a related
24investigation. However, nothing in this division shall require the
25disclosure of that portion of those investigative files that reflects
26the analysis or conclusions of the investigating officer.

27Customer lists provided to a state or local police agency by an
28alarm or security company at the request of the agency shall be
29construed to be records subject to this subdivision.

30Notwithstanding any other provision of this subdivision, state
31and local law enforcement agencies shall make public the following
32information, except to the extent that disclosure of a particular
33item of information would endanger the safety of a person involved
34in an investigation or would endanger the successful completion
35of the investigation or a related investigation:

36(1) The full name and occupation of every individual arrested
37by the agency, the individual’s physical description including date
38of birth, color of eyes and hair, sex, height and weight, the time
39and date of arrest, the time and date of booking, the location of
40the arrest, the factual circumstances surrounding the arrest, the
P14   1amount of bail set, the time and manner of release or the location
2where the individual is currently being held, and all charges the
3individual is being held upon, including any outstanding warrants
4from other jurisdictions and parole or probation holds.

5(2) Subject to the restrictions imposed by Section 841.5 of the
6Penal Code, the time, substance, and location of all complaints or
7requests for assistance received by the agency and the time and
8nature of the response thereto, including, to the extent the
9information regarding crimes alleged or committed or any other
10incident investigated is recorded, the time, date, and location of
11occurrence, the time and date of the report, the name and age of
12the victim, the factual circumstances surrounding the crime or
13incident, and a general description of any injuries, property, or
14weapons involved. The name of a victim of any crime defined by
15Section 220, 236.1, 261, 261.5, 262, 264, 264.1, 265, 266, 266a,
16266b, 266c, 266e, 266f, 266j, 267, 269, 273a, 273d, 273.5, 285,
17286, 288, 288a, 288.2, 288.3 (as added by Chapter 337 of the
18Statutes of 2006), 288.3 (as added by Section 6 of Proposition 83
19of the November 7, 2006, statewide general election), 288.5, 288.7,
20289, 422.6, 422.7, 422.75, 646.9, or 647.6 of the Penal Code may
21be withheld at the victim’s request, or at the request of the victim’s
22parent or guardian if the victim is a minor. When a person is the
23victim of more than one crime, information disclosing that the
24person is a victim of a crime defined in any of the sections of the
25Penal Code set forth in this subdivision may be deleted at the
26request of the victim, or the victim’s parent or guardian if the
27victim is a minor, in making the report of the crime, or of any
28crime or incident accompanying the crime, available to the public
29in compliance with the requirements of this paragraph.

30(3) Subject to the restrictions of Section 841.5 of the Penal Code
31and this subdivision, the current address of every individual
32arrested by the agency and the current address of the victim of a
33crime, where the requester declares under penalty of perjury that
34the request is made for a scholarly, journalistic, political, or
35governmental purpose, or that the request is made for investigation
36purposes by a licensed private investigator as described in Chapter
3711.3 (commencing with Section 7512) of Division 3 of the Business
38and Professions Code. However, the address of the victim of any
39crime defined by Section 220, 236.1, 261, 261.5, 262, 264, 264.1,
40265, 266, 266a, 266b, 266c, 266e, 266f, 266j, 267, 269, 273a,
P15   1273d, 273.5, 285, 286, 288, 288a, 288.2, 288.3 (as added by
2Chapter 337 of the Statutes of 2006), 288.3 (as added by Section
36 of Proposition 83 of the November 7, 2006, statewide general
4election), 288.5, 288.7, 289, 422.6, 422.7, 422.75, 646.9, or 647.6
5of the Penal Code shall remain confidential. Address information
6obtained pursuant to this paragraph may not be used directly or
7indirectly, or furnished to another, to sell a product or service to
8any individual or group of individuals, and the requester shall
9execute a declaration to that effect under penalty of perjury.
10Nothing in this paragraph shall be construed to prohibit or limit a
11scholarly, journalistic, political, or government use of address
12information obtained pursuant to this paragraph.

13(g) Test questions, scoring keys, and other examination data
14used to administer a licensing examination, examination for
15employment, or academic examination, except as provided for in
16Chapter 3 (commencing with Section 99150) of Part 65 of Division
1714 of Title 3 of the Education Code.

18(h) The contents of real estate appraisals or engineering or
19feasibility estimates and evaluations made for or by the state or
20local agency relative to the acquisition of property, or to
21prospective public supply and construction contracts, until all of
22the property has been acquired or all of the contract agreement
23obtained. However, the law of eminent domain shall not be affected
24by this provision.

25(i) Information required from any taxpayer in connection with
26the collection of local taxes that is received in confidence and the
27disclosure of the information to other persons would result in unfair
28competitive disadvantage to the person supplying the information.

29(j) Library circulation records kept for the purpose of identifying
30the borrower of items available in libraries, and library and museum
31materials made or acquired and presented solely for reference or
32 exhibition purposes. The exemption in this subdivision shall not
33apply to records of fines imposed on the borrowers.

34(k) Records, the disclosure of which is exempted or prohibited
35pursuant to federal or state law, including, but not limited to,
36provisions of the Evidence Code relating to privilege.

37(l) Correspondence of and to the Governor or employees of the
38Governor’s office or in the custody of or maintained by the
39Governor’s Legal Affairs Secretary. However, public records shall
P16   1not be transferred to the custody of the Governor’s Legal Affairs
2Secretary to evade the disclosure provisions of this chapter.

3(m) In the custody of or maintained by the Legislative Counsel,
4except those records in the public database maintained by the
5Legislative Counsel that are described in Section 10248.

6(n) Statements of personal worth or personal financial data
7required by a licensing agency and filed by an applicant with the
8licensing agency to establish his or her personal qualification for
9the license, certificate, or permit applied for.

10(o) Financial data contained in applications for financing under
11Division 27 (commencing with Section 44500) of the Health and
12Safety Code, where an authorized officer of the California Pollution
13Control Financing Authority determines that disclosure of the
14financial data would be competitively injurious to the applicant
15and the data is required in order to obtain guarantees from the
16United States Small Business Administration. The California
17Pollution Control Financing Authority shall adopt rules for review
18of individual requests for confidentiality under this section and for
19making available to the public those portions of an application that
20 are subject to disclosure under this chapter.

21(p) Records of state agencies related to activities governed by
22Chapter 10.3 (commencing with Section 3512), Chapter 10.5
23(commencing with Section 3525), and Chapter 12 (commencing
24with Section 3560) of Division 4, that reveal a state agency’s
25deliberative processes, impressions, evaluations, opinions,
26recommendations, meeting minutes, research, work products,
27theories, or strategy, or that provide instruction, advice, or training
28to employees who do not have full collective bargaining and
29representation rights under these chapters. Nothing in this
30subdivision shall be construed to limit the disclosure duties of a
31state agency with respect to any other records relating to the
32activities governed by the employee relations acts referred to in
33this subdivision.

34(q) (1) Records of state agencies related to activities governed
35by Article 2.6 (commencing with Section 14081), Article 2.8
36(commencing with Section 14087.5), and Article 2.91
37(commencing with Section 14089) of Chapter 7 of Part 3 of
38Division 9 of the Welfare and Institutions Code, that reveal the
39special negotiator’s deliberative processes, discussions,
40communications, or any other portion of the negotiations with
P17   1providers of health care services, impressions, opinions,
2recommendations, meeting minutes, research, work product,
3theories, or strategy, or that provide instruction, advice, or training
4to employees.

5(2) Except for the portion of a contract containing the rates of
6payment, contracts for inpatient services entered into pursuant to
7these articles, on or after April 1, 1984, shall be open to inspection
8one year after they are fully executed. If a contract for inpatient
9services that is entered into prior to April 1, 1984, is amended on
10or after April 1, 1984, the amendment, except for any portion
11containing the rates of payment, shall be open to inspection one
12year after it is fully executed. If the California Medical Assistance
13Commission enters into contracts with health care providers for
14other than inpatient hospital services, those contracts shall be open
15to inspection one year after they are fully executed.

16(3) Three years after a contract or amendment is open to
17inspection under this subdivision, the portion of the contract or
18amendment containing the rates of payment shall be open to
19inspection.

20(4) Notwithstanding any other provision of law, the entire
21contract or amendment shall be open to inspection by the Joint
22Legislative Audit Committee and the Legislative Analyst’s Office.
23The committee and that office shall maintain the confidentiality
24of the contracts and amendments until the time a contract or
25amendment is fully open to inspection by the public.

26(r) Records of Native American graves, cemeteries, and sacred
27places and records of Native American places, features, and objects
28described in Sections 5097.9 and 5097.993 of the Public Resources
29Code maintained by, or in the possession of, the Native American
30Heritage Commission, another state agency, or a local agency.

31(s) A final accreditation report of the Joint Commission on
32Accreditation of Hospitals that has been transmitted to the State
33Department of Health Care Services pursuant to subdivision (b)
34of Section 1282 of the Health and Safety Code.

35(t) Records of a local hospital district, formed pursuant to
36Division 23 (commencing with Section 32000) of the Health and
37Safety Code, or the records of a municipal hospital, formed
38pursuant to Article 7 (commencing with Section 37600) or Article
398 (commencing with Section 37650) of Chapter 5 of Part 2 of
40Division 3 of Title 4 of this code, that relate to any contract with
P18   1an insurer or nonprofit hospital service plan for inpatient or
2outpatient services for alternative rates pursuant to Section 10133
3of the Insurance Code. However, the record shall be open to
4inspection within one year after the contract is fully executed.

5(u) (1) Information contained in applications for licenses to
6carry firearms issued pursuant to Section 26150, 26155, 26170,
7or 26215 of the Penal Code by the sheriff of a county or the chief
8or other head of a municipal police department that indicates when
9or where the applicant is vulnerable to attack or that concerns the
10applicant’s medical or psychological history or that of members
11of his or her family.

12(2) The home address and telephone number of prosecutors,
13public defenders, peace officers, judges, court commissioners, and
14magistrates that are set forth in applications for licenses to carry
15firearms issued pursuant to Section 26150, 26155, 26170, or 26215
16of the Penal Code by the sheriff of a county or the chief or other
17head of a municipal police department.

18(3) The home address and telephone number of prosecutors,
19public defenders, peace officers, judges, court commissioners, and
20magistrates that are set forth in licenses to carry firearms issued
21pursuant to Section 26150, 26155, 26170, or 26215 of the Penal
22Code by the sheriff of a county or the chief or other head of a
23municipal police department.

24(v) (1) Records of the Managed Risk Medical Insurance Board
25and the State Department of Health Care Services related to
26activities governed by Part 6.3 (commencing with Section 12695),
27Part 6.5 (commencing with Section 12700), Part 6.6 (commencing
28with Section 12739.5), and Part 6.7 (commencing with Section
2912739.70) of Division 2 of the Insurance Code, and Chapter 2
30(commencing with Section 15850) of Part 3.3 of Division 9 of the
31Welfare and Institutions Code, and that reveal any of the following:

32(A) The deliberative processes, discussions, communications,
33or any other portion of the negotiations with entities contracting
34or seeking to contract with the board or the department, entities
35with which the board or the department is considering a contract,
36 or entities with which the board is considering or enters into any
37other arrangement under which the board or the department
38provides, receives, or arranges services or reimbursement.

39(B) The impressions, opinions, recommendations, meeting
40minutes, research, work product, theories, or strategy of the board
P19   1or its staff or the department or its staff, or records that provide
2instructions, advice, or training to their employees.

3(2) (A) Except for the portion of a contract that contains the
4rates of payment, contracts entered into pursuant to Part 6.3
5(commencing with Section 12695), Part 6.5 (commencing with
6Section 12700), Part 6.6 (commencing with Section 12739.5), or
7Part 6.7 (commencing with Section 12739.70) of Division 2 of the
8Insurance Code, or Chapter 2.2 (commencing with Section 15850)
9of Part 3.3 of Division 9 of the Welfare and Institutions Code, on
10or after July 1, 1991, shall be open to inspection one year after
11their effective dates.

12(B) If a contract that is entered into prior to July 1, 1991, is
13amended on or after July 1, 1991, the amendment, except for any
14portion containing the rates of payment, shall be open to inspection
15one year after the effective date of the amendment.

16(3) Three years after a contract or amendment is open to
17inspection pursuant to this subdivision, the portion of the contract
18or amendment containing the rates of payment shall be open to
19inspection.

20(4) Notwithstanding any other law, the entire contract or
21amendments to a contract shall be open to inspection by the Joint
22Legislative Audit Committee. The committee shall maintain the
23confidentiality of the contracts and amendments thereto, until the
24contracts or amendments to the contracts are open to inspection
25pursuant to paragraph (3).

26(w) (1) Records of the Managed Risk Medical Insurance Board
27related to activities governed by Chapter 8 (commencing with
28Section 10700) of Part 2 of Division 2 of the Insurance Code, and
29that reveal the deliberative processes, discussions, communications,
30or any other portion of the negotiations with health plans, or the
31impressions, opinions, recommendations, meeting minutes,
32research, work product, theories, or strategy of the board or its
33staff, or records that provide instructions, advice, or training to
34employees.

35(2) Except for the portion of a contract that contains the rates
36of payment, contracts for health coverage entered into pursuant to
37Chapter 8 (commencing with Section 10700) of Part 2 of Division
382 of the Insurance Code, on or after January 1, 1993, shall be open
39to inspection one year after they have been fully executed.

P20   1(3) Notwithstanding any other law, the entire contract or
2amendments to a contract shall be open to inspection by the Joint
3Legislative Audit Committee. The committee shall maintain the
4confidentiality of the contracts and amendments thereto, until the
5contracts or amendments to the contracts are open to inspection
6pursuant to paragraph (2).

7(x) Financial data contained in applications for registration, or
8 registration renewal, as a service contractor filed with the Director
9of Consumer Affairs pursuant to Chapter 20 (commencing with
10Section 9800) of Division 3 of the Business and Professions Code,
11for the purpose of establishing the service contractor’s net worth,
12or financial data regarding the funded accounts held in escrow for
13service contracts held in force in this state by a service contractor.

14(y) (1) Records of the Managed Risk Medical Insurance Board
15related to activities governed by Part 6.2 (commencing with Section
1612693) or Part 6.4 (commencing with Section 12699.50) of
17Division 2 of the Insurance Code, and that reveal any of the
18following:

19(A) The deliberative processes, discussions, communications,
20or any other portion of the negotiations with entities contracting
21or seeking to contract with the board, entities with which the board
22is considering a contract, or entities with which the board is
23considering or enters into any other arrangement under which the
24board provides, receives, or arranges services or reimbursement.

25(B) The impressions, opinions, recommendations, meeting
26minutes, research, work product, theories, or strategy of the board
27or its staff, or records that provide instructions, advice, or training
28to employees.

29(2) (A) Except for the portion of a contract that contains the
30rates of payment, contracts entered into pursuant to Part 6.2
31(commencing with Section 12693) or Part 6.4 (commencing with
32Section 12699.50) of Division 2 of the Insurance Code, on or after
33January 1, 1998, shall be open to inspection one year after their
34effective dates.

35(B) If a contract entered into pursuant to Part 6.2 (commencing
36with Section 12693) or Part 6.4 (commencing with Section
3712699.50) of Division 2 of the Insurance Code is amended, the
38amendment shall be open to inspection one year after the effective
39date of the amendment.

P21   1(3) Three years after a contract or amendment is open to
2inspection pursuant to this subdivision, the portion of the contract
3or amendment containing the rates of payment shall be open to
4inspection.

5(4) Notwithstanding any other law, the entire contract or
6amendments to a contract shall be open to inspection by the Joint
7Legislative Audit Committee. The committee shall maintain the
8confidentiality of the contracts and amendments thereto until the
9contract or amendments to a contract are open to inspection
10pursuant to paragraph (2) or (3).

11(5) The exemption from disclosure provided pursuant to this
12subdivision for the contracts, deliberative processes, discussions,
13communications, negotiations, impressions, opinions,
14recommendations, meeting minutes, research, work product,
15theories, or strategy of the board or its staff shall also apply to the
16contracts, deliberative processes, discussions, communications,
17negotiations, impressions, opinions, recommendations, meeting
18minutes, research, work product, theories, or strategy of applicants
19pursuant to Part 6.4 (commencing with Section 12699.50) of
20Division 2 of the Insurance Code.

21(z) Records obtained pursuant to paragraph (2) of subdivision
22(f) of Section 2891.1 of the Public Utilities Code.

23(aa) A document prepared by or for a state or local agency that
24assesses its vulnerability to terrorist attack or other criminal acts
25intended to disrupt the public agency’s operations and that is for
26distribution or consideration in a closed session.

27(ab) Critical infrastructure information, as defined in Section
28131(3) of Title 6 of the United States Code, that is voluntarily
29submitted to the California Emergency Management Agency for
30use by that office, including the identity of the person who or entity
31that voluntarily submitted the information. As used in this
32subdivision, “voluntarily submitted” means submitted in the
33absence of the office exercising any legal authority to compel
34access to or submission of critical infrastructure information. This
35subdivision shall not affect the status of information in the
36possession of any other state or local governmental agency.

37(ac) All information provided to the Secretary of State by a
38person for the purpose of registration in the Advance Health Care
39Directive Registry, except that those records shall be released at
P22   1the request of a health care provider, a public guardian, or the
2 registrant’s legal representative.

3(ad) The following records of the State Compensation Insurance
4Fund:

5(1) Records related to claims pursuant to Chapter 1
6(commencing with Section 3200) of Division 4 of the Labor Code,
7to the extent that confidential medical information or other
8individually identifiable information would be disclosed.

9(2) Records related to the discussions, communications, or any
10other portion of the negotiations with entities contracting or seeking
11to contract with the fund, and any related deliberations.

12(3) Records related to the impressions, opinions,
13recommendations, meeting minutes of meetings or sessions that
14are lawfully closed to the public, research, work product, theories,
15or strategy of the fund or its staff, on the development of rates,
16contracting strategy, underwriting, or competitive strategy pursuant
17to the powers granted to the fund in Chapter 4 (commencing with
18Section 11770) of Part 3 of Division 2 of the Insurance Code.

19(4) Records obtained to provide workers’ compensation
20insurance under Chapter 4 (commencing with Section 11770) of
21Part 3 of Division 2 of the Insurance Code, including, but not
22limited to, any medical claims information, policyholder
23information provided that nothing in this paragraph shall be
24interpreted to prevent an insurance agent or broker from obtaining
25proprietary information or other information authorized by law to
26be obtained by the agent or broker, and information on rates,
27pricing, and claims handling received from brokers.

28(5) (A) Records that are trade secrets pursuant to Section
296276.44, or Article 11 (commencing with Section 1060) of Chapter
304 of Division 8 of the Evidence Code, including without limitation,
31instructions, advice, or training provided by the State Compensation
32Insurance Fund to its board members, officers, and employees
33regarding the fund’s special investigation unit, internal audit unit,
34and informational security, marketing, rating, pricing, underwriting,
35claims handling, audits, and collections.

36(B) Notwithstanding subparagraph (A), the portions of records
37containing trade secrets shall be available for review by the Joint
38Legislative Audit Committee, the Bureau of State Audits, Division
39of Workers’ Compensation, and the Department of Insurance to
40ensure compliance with applicable law.

P23   1(6) (A) Internal audits containing proprietary information and
2the following records that are related to an internal audit:

3(i) Personal papers and correspondence of any person providing
4assistance to the fund when that person has requested in writing
5that his or her papers and correspondence be kept private and
6confidential. Those papers and correspondence shall become public
7records if the written request is withdrawn, or upon order of the
8fund.

9(ii) Papers, correspondence, memoranda, or any substantive
10information pertaining to any audit not completed or an internal
11audit that contains proprietary information.

12(B) Notwithstanding subparagraph (A), the portions of records
13containing proprietary information, or any information specified
14in subparagraph (A) shall be available for review by the Joint
15Legislative Audit Committee, the Bureau of State Audits, Division
16of Workers’ Compensation, and the Department of Insurance to
17ensure compliance with applicable law.

18(7) (A) Except as provided in subparagraph (C), contracts
19entered into pursuant to Chapter 4 (commencing with Section
2011770) of Part 3 of Division 2 of the Insurance Code shall be open
21to inspection one year after the contract has been fully executed.

22(B) If a contract entered into pursuant to Chapter 4 (commencing
23with Section 11770) of Part 3 of Division 2 of the Insurance Code
24is amended, the amendment shall be open to inspection one year
25after the amendment has been fully executed.

26(C) Three years after a contract or amendment is open to
27inspection pursuant to this subdivision, the portion of the contract
28or amendment containing the rates of payment shall be open to
29inspection.

30(D) Notwithstanding any other law, the entire contract or
31amendments to a contract shall be open to inspection by the Joint
32Legislative Audit Committee. The committee shall maintain the
33confidentiality of the contracts and amendments thereto until the
34contract or amendments to a contract are open to inspection
35pursuant to this paragraph.

36(E) This paragraph is not intended to apply to documents related
37to contracts with public entities that are not otherwise expressly
38confidential as to that public entity.

P24   1(F) For purposes of this paragraph, “fully executed” means the
2point in time when all of the necessary parties to the contract have
3signed the contract.

4This section shall not prevent any agency from opening its
5records concerning the administration of the agency to public
6inspection, unless disclosure is otherwise prohibited by law.

7This section shall not prevent any health facility from disclosing
8to a certified bargaining agent relevant financing information
9pursuant to Section 8 of the National Labor Relations Act (29
10U.S.C. Sec. 158).

11

SEC. 3.  

Section 26605.6 of the Government Code is amended
12to read:

13

26605.6.  

(a) The sheriff, or his or her designee, has the
14authority, after conferring with a physician who has oversight for
15providing medical care at a county jail, or that physician’s designee,
16to release from a county correctional facility, a prisoner sentenced
17to a county jail if the sheriff determines that the prisoner would
18not reasonably pose a threat to public safety and the prisoner, upon
19diagnosis by the examining physician, is deemed to have a life
20expectancy of six months or less.

21(b) Before the release of any prisoner pursuant to this section,
22the sheriff shall notify the presiding judge of the superior court of
23his or her intention to release the prisoner. This notification shall
24include:

25(1) The prisoner’s name.

26(2) The offense or offenses for which the prisoner was
27incarcerated, if applicable, and the pending charges, if applicable.

28(3) The date of sentence, if applicable.

29(4) The physician’s diagnosis of the prisoner’s condition.

30(5) The physician’s prognosis for the prisoner’s recovery.

31(6) The prisoner’s address after release.

32(c) (1) This section shall be implemented only to the extent that
33a county that releases a prisoner pursuant to this section does both
34of the following:

35(A) Sends a letter to the State Department of Health Care
36Services agreeing to do both of the following:

37(i) Notify the State Department of Health Care Services, in
38writing, when a prisoner released pursuant to this section has
39applied for Medi-Cal.

P25   1(ii) Notify the State Department of Health Care Services, in
2writing, if a prisoner released pursuant to this section, who is
3Medi-Cal eligible, is returned to the custody of the sheriff.

4(B) For the period of time that the offender would otherwise
5have been incarcerated:

6(i) Reimburses the State Department of Health Care Services
7for the nonfederal share of the Medi-Cal costs and any medical
8costs paid by the State Department of Health Care Services that
9are not reimbursable pursuant to Title XIX or XXI of the federal
10Social Security Act, for an offender released pursuant to this
11section.

12(ii) Provides to the State Department of Health Care Services
13the nonfederal share of the state’s administrative costs associated
14with this section.

15(2) It is the intent of the Legislature that the implementation of
16this section shall not result in increased costs to the General Fund.

17(3) Participation in the program under this section is voluntary
18for purposes of all applicable federal law. This section shall be
19implemented only to the extent that federal financial participation
20for the Medi-Cal program is not jeopardized.

21(d) Before a prisoner’s compassionate release from a county
22jail pursuant to this section, the sheriff, or his or her designee, shall
23secure a placement option for the prisoner in the community and,
24in consultation with the county welfare department or another
25applicable county agency, examine the prisoner’s eligibility for
26federal Medicaid benefits or other medical coverage that might
27assist in funding the prisoner’s medical treatment while in the
28community.

29(e) (1) For any prisoner released pursuant to this section who
30is eligible for Medi-Cal, the county shall continue to pay the
31nonfederal share of the prisoner’s Medi-Cal costs for the period
32of time that the offender would have otherwise been incarcerated.

33(2) For any prisoner granted compassionate release pursuant to
34this section who is ineligible for Medi-Cal, the county shall
35consider whether the prisoner has private medical insurance or
36sufficient income or assets to provide for his or her own medical
37care. If the county determines that the prisoner can provide for his
38or her own medical care, the county shall not be required to provide
39the prisoner with medical care.

P26   1(f) This section shall not be construed as authorizing the sheriff
2to refuse to receive and incarcerate a defendant or sentenced
3individual who is not in need of immediate medical care or who
4has a terminal medical condition.

5(g) Notwithstanding any other law, the State Department of
6Health Care Services may exempt individuals released pursuant
7to this section from mandatory enrollment in managed health care,
8including county-organized health plans and, as deemed necessary
9by the State Department of Health Care Services, may determine
10the proper prior authorization process for individuals who have
11been released pursuant to this section.

12(h) Notwithstanding Chapter 3.5 (commencing with Section
1311340) of Part 1 of Division 3 of Title 2, the State Department of
14Health Care Services, without taking any further regulatory action,
15shall implement, interpret, and make specific this section by means
16of provider bulletins, all-county letters, manuals, or similar
17instructions until the time that regulations are adopted. Thereafter,
18the department shall adopt regulations in accordance with Chapter
193.5 (commencing with Section 11340) of Part 1 of Division 3 of
20Title 2. Six months after the effective date of the act that added
21this subdivision, the department shall provide a status update to
22the Legislature on its efforts to adopt the regulations. Thereafter,
23notwithstanding Section 10231.5, the department shall report on
24the status of this effort to the Legislature on an annual basis, until
25the regulations have been adopted.

26

SEC. 4.  

Section 26605.7 of the Government Code is amended
27to read:

28

26605.7.  

(a) The sheriff, or his or her designee, after conferring
29with the physician who has oversight for providing medical care,
30or the physician’s designee, may request the court to grant medical
31probation or to resentence a prisoner to medical probation in lieu
32of jail time for any prisoner sentenced to a county jail under either
33of the following circumstances:

34(1) The prisoner is physically incapacitated with a medical
35condition that renders the prisoner permanently unable to perform
36activities of basic daily living, which has resulted in the prisoner
37requiring 24-hour care, if that incapacitation did not exist at the
38time of sentencing.

39(2) The prisoner would require acute long-term inpatient
40 rehabilitation services.

P27   1(b) Before a prisoner’s release to medical probation, the sheriff,
2or his or her designee, shall secure a placement option for the
3prisoner in the community and, in consultation with the county
4welfare department or another applicable county agency, examine
5the prisoner’s eligibility for federal Medicaid benefits or other
6medical coverage that might assist in funding the prisoner’s
7medical treatment while in the community.

8(c) During the time on probation pursuant to this section, the
9probation officer or court may, at any time, request a medical
10reexamination of the probationer by a physician who has oversight
11for providing medical care to prisoners in a county jail, or the
12physician’s designee. If the court determines, based on that medical
13examination, that the probationer’s medical condition has improved
14to the extent that the probationer no longer qualifies for medical
15probation, the court may return the probationer to the custody of
16the sheriff.

17(d) (1) For any probationer granted medical probation pursuant
18to this section who is eligible for Medi-Cal, the county shall
19continue to pay the nonfederal share of the probationer’s Medi-Cal
20costs. After a probationer is released from medical probation, the
21county shall no longer be required to pay the nonfederal share of
22the Medi-Cal costs.

23(2) For any probationer granted medical probation pursuant to
24this section who is ineligible for Medi-Cal, the county shall
25consider whether the probationer has private medical insurance or
26sufficient income or assets to provide for his or her own medical
27care. If the county determines that the probationer can provide for
28his or her own medical care, the county shall not be required to
29provide the probationer with medical care.

30(e) (1) This section shall be implemented only to the extent that
31a court sentences a person to medical probation pursuant to this
32section and the sheriff does both of the following:

33(A) Sends a letter to the State Department of Health Care
34Services agreeing to do both of the following:

35(i) Notify the State Department of Health Care Services, in
36writing, when a probationer released pursuant to this section has
37applied for Medi-Cal.

38(ii) Notify the State Department of Health Care Services, in
39writing, if a probationer released pursuant to this section, who is
40Medi-Cal eligible, is returned to the custody of the sheriff. The
P28   1chief probation officer shall notify the State Department of Health
2Care Services, in writing, when a Medi-Cal eligible probationer’s
3term of medical probation ends.

4(B) For the period of time the offender is on medical probation:

5(i) Reimburses the State Department of Health Care Services
6for the nonfederal share of the Medi-Cal costs and any medical
7costs paid by the State Department of Health Care Services that
8are not reimbursable pursuant to Title XIX or XXI of the federal
9Social Security Act, for an offender released pursuant to this
10section.

11(ii) Provides to the State Department of Health Care Services
12the nonfederal share of the state’s administrative costs associated
13with this section.

14(2) It is the intent of the Legislature that the implementation of
15this section shall not result in increased costs to the General Fund.

16(3) Participation in the program under this section is voluntary
17for purposes of all applicable federal law. This section shall be
18implemented only to the extent that federal financial participation
19for the Medi-Cal program is not jeopardized.

20(f) Notwithstanding any other law, the State Department of
21Health Care Services may exempt individuals released pursuant
22to this section from mandatory enrollment in managed health care,
23including county-organized health plans and, as deemed necessary
24by the State Department of Health Care Services, may determine
25the proper prior authorization process for individuals who have
26been released pursuant to this section.

27(g) Notwithstanding Chapter 3.5 (commencing with Section
2811340) of Part 1 of Division 3 of Title 2, the State Department of
29Health Care Services, without taking any further regulatory action,
30may implement, interpret, and make specific this section by means
31of provider bulletins, all-county letters, manuals, or similar
32instructions until the time that regulations are adopted. Thereafter,
33the department shall adopt regulations in accordance with Chapter
343.5 (commencing with Section 11340) of Part 1 of Division 3 of
35Title 2. Six months after the effective date of the act that added
36this subdivision, the department shall provide a status update to
37the Legislature on its efforts to adopt the regulations. Thereafter,
38notwithstanding Section 10231.5, the department shall report on
39the status of this effort to the Legislature on an annual basis, until
40the regulations have been adopted.

P29   1

SEC. 5.  

Section 26605.8 of the Government Code is amended
2to read:

3

26605.8.  

Before implementing Sections 26605.6 and 26605.7,
4the county board of supervisors shall adopt a process to fund the
5nonfederal share of Medi-Cal costs for the period of time that a
6prisoner would have otherwise been incarcerated or for the period
7of time that a probationer is on medical probation. The county
8board of supervisors shall provide the State Department of Health
9Care Services with written notification of the process.

10

SEC. 6.  

Section 1180.6 of the Health and Safety Code is
11amended to read:

12

1180.6.  

The State Department of Public Health, the State
13Department of State Hospitals, the State Department of Social
14Services, the State Department of Developmental Services, and
15the State Department of Health Care Services shall annually
16provide information to the Legislature, during Senate and Assembly
17budget committee hearings, about the progress made in
18implementing this division. This information shall include the
19progress of implementation and barriers to achieving full
20implementation.

21

SEC. 7.  

Section 1250.2 of the Health and Safety Code is
22amended to read:

23

1250.2.  

(a) (1) As defined in Section 1250, “health facility”
24includes a “psychiatric health facility,” defined to mean a health
25facility, licensed by the State Department of Health Care Services,
26that provides 24-hour inpatient care for mentally disordered,
27incompetent, or other persons described in Division 5 (commencing
28with Section 5000) or Division 6 (commencing with Section 6000)
29of the Welfare and Institutions Code. This care shall include, but
30not be limited to, the following basic services: psychiatry, clinical
31psychology, psychiatric nursing, social work, rehabilitation, drug
32administration, and appropriate food services for those persons
33whose physical health needs can be met in an affiliated hospital
34or in outpatient settings.

35(2) It is the intent of the Legislature that the psychiatric health
36facility shall provide a distinct type of service to psychiatric
37patients in a 24-hour acute inpatient setting. The State Department
38of Health Care Services shall require regular utilization reviews
39of admission and discharge criteria and lengths of stay in order to
P30   1assure that these patients are moved to less restrictive levels of
2care as soon as appropriate.

3(b) (1) The State Department of Health Care Services may issue
4a special permit to a psychiatric health facility for it to provide
5structured outpatient services (commonly referred to as SOPS)
6consisting of morning, afternoon, or full daytime organized
7programs, not exceeding 10 hours, for acute daytime care for
8patients admitted to the facility. This subdivision shall not be
9construed as requiring a psychiatric health facility to apply for a
10special permit to provide these alternative levels of care.

11(2) The Legislature recognizes that, with access to structured
12outpatient services, as an alternative to 24-hour inpatient care,
13certain patients would be provided with effective intervention and
14less restrictive levels of care. The Legislature further recognizes
15that, for certain patients, the less restrictive levels of care eliminate
16the need for inpatient care, enable earlier discharge from inpatient
17care by providing a continuum of care with effective aftercare
18services, or reduce or prevent the need for a subsequent readmission
19to inpatient care.

20(c) Any reference in any statute to Section 1250 of the Health
21and Safety Code shall be deemed and construed to also be a
22reference to this section.

23(d) Notwithstanding any other provision of law, and to the extent
24consistent with federal law, a psychiatric health facility shall be
25eligible to participate in the medicare program under Title XVIII
26of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.),
27and the medicaid program under Title XIX of the federal Social
28Security Act (42 U.S.C. Sec. 1396 et seq.), if all of the following
29conditions are met:

30(1) The facility is a licensed facility.

31(2) The facility is in compliance with all related statutes and
32regulations enforced by the State Department of Health Care
33Services, including regulations contained in Chapter 9
34(commencing with Section 77001) of Division 5 of Title 22 of the
35California Code of Regulations.

36(3) The facility meets the definitions and requirements contained
37in subdivisions (e) and (f) of Section 1861 of the federal Social
38 Security Act (42 U.S.C. Sec. 1395x(e) and (f)), including the
39approval process specified in Section 1861(e)(7)(B) of the federal
40Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which
P31   1requires that the state agency responsible for licensing hospitals
2has assured that the facility meets licensing requirements.

3(4) The facility meets the conditions of participation for hospitals
4pursuant to Part 482 of Title 42 of the Code of Federal Regulations.

5

SEC. 8.  

Section 1254 of the Health and Safety Code is amended
6to read:

7

1254.  

(a) Except as provided in subdivision (e), the state
8department shall inspect and license health facilities. The state
9department shall license health facilities to provide their respective
10basic services specified in Section 1250. Except as provided in
11Section 1253, the state department shall inspect and approve a
12general acute care hospital to provide special services as specified
13in Section 1255. The state department shall develop and adopt
14regulations to implement the provisions contained in this section.

15(b) Upon approval, the state department shall issue a separate
16license for the provision of the basic services enumerated in
17subdivision (c) or (d) of Section 1250 whenever these basic services
18are to be provided by an acute care hospital, as defined in
19 subdivision (a), (b), or (f) of that section, where the services
20enumerated in subdivision (c) or (d) of Section 1250 are to be
21provided in any separate freestanding facility, whether or not the
22location of the separate freestanding facility is contiguous to the
23acute care hospital. The same requirement shall apply to any new
24freestanding facility constructed for the purpose of providing basic
25services, as defined in subdivision (c) or (d) of Section 1250, by
26any acute care hospital on or after January 1, 1984.

27(c) (1) Those beds licensed to an acute care hospital which,
28prior to January 1, 1984, were separate freestanding beds and were
29not part of the physical structure licensed to provide acute care,
30and which beds were licensed to provide those services enumerated
31in subdivision (c) or (d) of Section 1250, are exempt from the
32requirements of subdivision (b).

33(2) All beds licensed to an acute care hospital and located within
34the physical structure in which acute care is provided are exempt
35from the requirements of subdivision (b) irrespective of the date
36of original licensure of the beds, or the licensed category of the
37beds.

38(3) All beds licensed to an acute care hospital owned and
39operated by the State of California or any other public agency are
40exempt from the requirements of subdivision (b).

P32   1(4) All beds licensed to an acute care hospital in a rural area as
2defined by Chapter 1010, of the Statutes of 1982, are exempt from
3the requirements of subdivision (b), except where there is a
4freestanding skilled nursing facility or intermediate care facility
5which has experienced an occupancy rate of 95 percent or less
6during the past 12 months within a 25-mile radius or which may
7be reached within 30 minutes using a motor vehicle.

8(5) All beds licensed to an acute care hospital which meet the
9criteria for designation within peer group six or eight, as defined
10in the report entitled Hospital Peer Grouping for Efficiency
11Comparison, dated December 20, 1982, and published by the
12California Health Facilities Commission, and all beds in hospitals
13which have fewer than 76 licensed acute care beds and which are
14located in a census designation place of 15,000 or less population,
15are exempt from the requirements of subdivision (b), except where
16there is a free-standing skilled nursing facility or intermediate care
17facility which has experienced an occupancy rate of 95 percent or
18less during the past 12 months within a 25-mile radius or which
19may be reached within 30 minutes using a motor vehicle.

20(6) All beds licensed to an acute care hospital which has had a
21certificate of need approved by a health systems agency on or
22before July 1, 1983, are exempt from the requirements of
23subdivision (b).

24(7) All beds licensed to an acute care hospital are exempt from
25the requirements of subdivision (b), if reimbursement from the
26Medi-Cal program for beds licensed for the provision of services
27enumerated in subdivision (c) or (d) of Section 1250 and not
28otherwise exempt does not exceed the reimbursement which would
29be received if the beds were in a separately licensed facility.

30(d) Except as provided in Section 1253, the state department
31shall inspect and approve a general acute care hospital to provide
32special services as specified in Section 1255. The state department
33shall develop and adopt regulations to implement subdivisions (a)
34to (d), inclusive, of this section.

35(e) The State Department of Health Care Services shall inspect
36and license psychiatric health facilities. The State Department of
37Health Care Services shall license psychiatric health facilities to
38provide their basic services specified in Section 1250.2. The State
39Department of Health Care Services shall develop, adopt, or amend
40regulations to implement this subdivision.

P33   1

SEC. 9.  

Section 1254.1 of the Health and Safety Code is
2amended to read:

3

1254.1.  

(a) The State Department of Health Care Services
4shall license psychiatric health facilities to provide their basic
5services specified in Section 1250.

6(b) Any reference in any statute to Section 1254 shall be deemed
7and construed to also be a reference to this section.

8

SEC. 10.  

Section 1266.1 of the Health and Safety Code is
9amended to read:

10

1266.1.  

(a) Each new or renewal application for a license for
11a psychiatric health facility shall be accompanied by a fee credited
12to the State Department of Health Care Services for its costs
13incurred in the review of psychiatric health facility programs, in
14connection with the licensing of these facilities. The amount of
15the fees shall be determined and collected by the State Department
16of Health Care Services, but the total amount of the fees collected
17shall not exceed the actual costs of licensure and review of
18psychiatric health facility programs, including, but not limited to,
19the costs of processing the application, inspection costs, and other
20related costs.

21(b) New or renewal licensure application fees for psychiatric
22health facilities shall be collected by the State Department of Health
23Care Services.

24(c) The annual fees shall be waived for any psychiatric health
25facility conducted, maintained, or operated by this state or any
26state department, authority, bureau, commission, or officer, or by
27the Regents of the University of California, or by a local hospital
28district, city, county, or city and county.

29(d) If additional private psychiatric health facilities seek new
30licensure on or after January 1, 1991, the State Department of
31Health Care Services may increase the fees for all private
32psychiatric health facilities with more than nine beds sufficient to
33accommodate the increased level of workload and costs.

34(e) (1) Any licensee desiring to obtain a special permit to offer
35and provide structured outpatient services shall file an application
36with the State Department of Health Care Services.

37(2) The application for a special permit, if any, shall be
38submitted with each new or renewal application for a license for
39a psychiatric health facility, and shall be accompanied by a
40reasonable fee, as determined by the State Department of Health
P34   1Care Services, not to exceed the actual costs of administration
2related to the special permit. An application for a special permit
3submitted by a psychiatric health facility operated by a public
4entity shall be exempt from the fee required pursuant to this section
5for the issuance of the special permit.

6(3) The State Department of Health Care Services shall not issue
7a special permit unless the applicant furnishes all of the following:

8(A) Its annual licensing fee required pursuant to subdivision
9(a).

10(B) A completed application submitted on forms furnished by
11the department.

12(C) A written agreement ensuring that the facility will have
13additional staffing for the services to be provided under the special
14permit, that the additional staffing will meet the same professional
15standards as required by regulation for inpatient services, and that
16a coordinator of these services will be appointed.

17(D) Any other information or documentation as may be required
18by the department for its proper and efficient administration and
19enforcement of special permit services.

20(4) The provision of structured outpatient services pursuant to
21a special permit may be as an alternative to admission to inpatient
22services, as aftercare services following discharge from inpatient
23care, or as both.

24

SEC. 11.  

Section 1275.1 of the Health and Safety Code is
25amended to read:

26

1275.1.  

(a) Notwithstanding any rules or regulations governing
27other health facilities, the regulations developed by the State
28Department of Health Care Services, or a predecessor, for
29psychiatric health facilities shall prevail. The regulations applying
30to psychiatric health facilities shall prescribe standards of adequacy,
31safety, and sanitation of the physical plant, of staffing with duly
32qualified licensed personnel, and of services based on the needs
33of the persons served thereby.

34(b) The regulations shall include standards appropriate for two
35levels of disorder:

36(1) Involuntary ambulatory psychiatric patients.

37(2) Voluntary ambulatory psychiatric patients.

38For purposes of this subdivision, “ambulatory patients” shall
39include, but not be limited to, deaf, blind, and physically
40handicapped persons. Disoriented persons who are not bedridden
P35   1or confined to a wheelchair shall also be considered as ambulatory
2patients.

3(c) The regulations shall not require, but may permit building
4and services requirements for hospitals which are only applicable
5to physical health care needs of patients that can be met in an
6affiliated hospital or in outpatient settings including, but not limited
7to, such requirements as surgical, dietary, laboratory, laundry,
8central supply, radiologic, and pharmacy.

9(d) The regulations shall include provisions for an “open
10planning” architectural concept.

11(e) The regulations shall exempt from seismic requirements all
12structures of Type V and of one-story construction.

13(f) Standards for involuntary patients shall include provisions
14to allow for restraint and seclusion of patients. These standards
15shall provide for adequate safeguards for patient safety and
16protection of patient rights.

17(g) The regulations shall provide for the retention by the
18psychiatric health facility of a consultant pharmacist, who shall
19supervise and review pharmaceutical services within the facility
20and perform any other services, including prevention of the
21unlawful diversion of controlled substances subject to abuse, as
22the State Department of Health Care Services may by regulation
23require. Regulations adopted pursuant to this subdivision shall
24take into consideration the varying bed sizes of psychiatric health
25facilities.

26

SEC. 12.  

Section 1275.5 of the Health and Safety Code is
27amended to read:

28

1275.5.  

(a) The regulations relating to the licensing of
29hospitals, heretofore adopted by the State Department of Public
30Health pursuant to former Chapter 2 (commencing with Section
311400) of Division 2, and in effect immediately prior to July 1,
321973, shall remain in effect and shall be fully enforceable with
33respect to any hospital required to be licensed by this chapter,
34unless and until the regulations are readopted, amended, or repealed
35by the director.

36(b) The regulations relating to private institutions receiving or
37caring for any mentally disordered persons, intellectually disabled
38persons, and other incompetent persons, heretofore adopted by the
39Department of Mental Hygiene pursuant to Chapter 1 (commencing
40with Section 7000) of Division 7 of the Welfare and Institutions
P36   1Code, and in effect immediately prior to July 1, 1973, shall remain
2in effect and shall be fully enforceable with respect to any facility,
3establishment, or institution for the reception and care of mentally
4disordered persons, intellectually disabled persons and other
5incompetent persons, required to be licensed by the provisions of
6this chapter unless and until said regulations are readopted,
7amended, or repealed by the director.

8(c) (1) All regulations relating to the licensing of psychiatric
9health facilities heretofore adopted by the State Department of
10Health Services, pursuant to authority now vested in the State
11Department of Health Care Services by Section 4080 of the Welfare
12and Institutions Code, and in effect immediately preceding
13September 20, 1988, shall remain in effect and shall be fully
14enforceable by the State Department of Health Care Services with
15respect to any facility or program required to be licensed as a
16psychiatric health facility, unless and until readopted, amended,
17or repealed by the Director of Health Care Services.

18(2) The State Department of Health Care Services shall succeed
19to and be vested with all duties, powers, purposes, functions,
20responsibilities, and jurisdiction as they relate to licensing
21psychiatric health facilities.

22

SEC. 13.  

Section 1324.9 of the Health and Safety Code is
23amended to read:

24

1324.9.  

(a) The Long-Term Care Quality Assurance Fund is
25hereby created in the State Treasury. Moneys in the fund shall be
26available, upon appropriation by the Legislature, for expenditure
27by the State Department of Health Care Services for the purposes
28of this article and Article 7.6 (commencing with Section 1324.20).
29Notwithstanding Section 16305.7 of the Government Code, the
30fund shall contain all interest and dividends earned on moneys in
31the fund.

32(b) Notwithstanding any other law, beginning August 1, 2013,
33all revenues received by the State Department of Health Care
34Services categorized by the State Department of Health Care
35Services as long-term care quality assurance fees shall be deposited
36into the Long-Term Care Quality Assurance Fund. Revenue that
37shall be deposited into this fund shall include quality assurance
38fees imposed pursuant to this article and quality assurance fees
39imposed pursuant to Article 7.6 (commencing with Section
401324.20).

P37   1(c) Notwithstanding any other law, the Controller may use the
2funds in the Long-Term Care Quality Assurance Fund for cashflow
3loans to the General Fund as provided in Sections 16310 and 16381
4of the Government Code.

5

SEC. 14.  

Section 1373 of the Health and Safety Code is
6amended to read:

7

1373.  

(a) (1) A plan contract may not provide an exception
8for other coverage if the other coverage is entitlement to Medi-Cal
9benefits under Chapter 7 (commencing with Section 14000) or
10Chapter 8 (commencing with Section 14200) of Part 3 of Division
119 of the Welfare and Institutions Code, or Medicaid benefits under
12Subchapter 19 (commencing with Section 1396) of Chapter 7 of
13Title 42 of the United States Code.

14(2) Each plan contract shall be interpreted not to provide an
15exception for the Medi-Cal or Medicaid benefits.

16(3) A plan contract shall not provide an exemption for
17enrollment because of an applicant’s entitlement to Medi-Cal
18benefits under Chapter 7 (commencing with Section 14000) or
19Chapter 8 (commencing with Section 14200) of Part 3 of Division
209 of the Welfare and Institutions Code, or Medicaid benefits under
21Subchapter 19 (commencing with Section 1396) of Chapter 7 of
22Title 42 of the United States Code.

23(4) A plan contract may not provide that the benefits payable
24thereunder are subject to reduction if the individual insured has
25entitlement to the Medi-Cal or Medicaid benefits.

26(b) (1) A plan contract that provides coverage, whether by
27specific benefit or by the effect of general wording, for sterilization
28operations or procedures shall not impose any disclaimer,
29restriction on, or limitation of, coverage relative to the covered
30individual’s reason for sterilization.

31(2) As used in this section, “sterilization operations or
32procedures” shall have the same meaning as that specified in
33Section 10120 of the Insurance Code.

34(c) Every plan contract that provides coverage to the spouse or
35dependents of the subscriber or spouse shall grant immediate
36accident and sickness coverage, from and after the moment of
37birth, to each newborn infant of any subscriber or spouse covered
38and to each minor child placed for adoption from and after the date
39on which the adoptive child’s birth parent or other appropriate
40legal authority signs a written document, including, but not limited
P38   1to, a health facility minor release report, a medical authorization
2form, or a relinquishment form, granting the subscriber or spouse
3the right to control health care for the adoptive child or, absent
4this written document, on the date there exists evidence of the
5subscriber’s or spouse’s right to control the health care of the child
6placed for adoption. No plan may be entered into or amended if it
7contains any disclaimer, waiver, or other limitation of coverage
8relative to the coverage or insurability of newborn infants of, or
9children placed for adoption with, a subscriber or spouse covered
10as required by this subdivision.

11(d) (1) Every plan contract that provides that coverage of a
12dependent child of a subscriber shall terminate upon attainment
13of the limiting age for dependent children specified in the plan,
14shall also provide that attainment of the limiting age shall not
15operate to terminate the coverage of the child while the child is
16and continues to meet both of the following criteria:

17(A) Incapable of self-sustaining employment by reason of a
18physically or mentally disabling injury, illness, or condition.

19(B) Chiefly dependent upon the subscriber for support and
20maintenance.

21(2) The plan shall notify the subscriber that the dependent child’s
22coverage will terminate upon attainment of the limiting age unless
23the subscriber submits proof of the criteria described in
24subparagraphs (A) and (B) of paragraph (1) to the plan within 60
25days of the date of receipt of the notification. The plan shall send
26this notification to the subscriber at least 90 days prior to the date
27the child attains the limiting age. Upon receipt of a request by the
28subscriber for continued coverage of the child and proof of the
29criteria described in subparagraphs (A) and (B) of paragraph (1),
30the plan shall determine whether the child meets that criteria before
31the child attains the limiting age. If the plan fails to make the
32determination by that date, it shall continue coverage of the child
33pending its determination.

34(3) The plan may subsequently request information about a
35dependent child whose coverage is continued beyond the limiting
36age under this subdivision but not more frequently than annually
37after the two-year period following the child’s attainment of the
38 limiting age.

39(4) If the subscriber changes carriers to another plan or to a
40health insurer, the new plan or insurer shall continue to provide
P39   1coverage for the dependent child. The new plan or insurer may
2request information about the dependent child initially and not
3more frequently than annually thereafter to determine if the child
4continues to satisfy the criteria in subparagraphs (A) and (B) of
5paragraph (1). The subscriber shall submit the information
6requested by the new plan or insurer within 60 days of receiving
7the request.

8(5) (A) Except as set forth in subparagraph (B), under no
9circumstances shall the limiting age be less than 26 years of age
10with respect to plan years beginning on or after September 23,
112010.

12(B) For plan years beginning before January 1, 2014, a group
13health care service plan contract that qualifies as a grandfathered
14health plan under Section 1251 of the federal Patient Protection
15and Affordable Care Act (Public Law 111-148) and that makes
16available dependent coverage of children may exclude from
17coverage an adult child who has not attained 26 years of age only
18if the adult child is eligible to enroll in an eligible
19employer-sponsored health plan, as defined in Section 5000A(f)(2)
20of the Internal Revenue Code, other than a group health plan of a
21parent.

22(C) (i) With respect to a child (I) whose coverage under a group
23or individual plan contract ended, or who was denied or not eligible
24for coverage under a group or individual plan contract, because
25under the terms of the contract the availability of dependent
26coverage of children ended before the attainment of 26 years of
27age, and (II) who becomes eligible for that coverage by reason of
28the application of this paragraph, the health care service plan shall
29give the child an opportunity to enroll that shall continue for at
30least 30 days. This opportunity and the notice described in clause
31(ii) shall be provided not later than the first day of the first plan
32year beginning on or after September 23, 2010, consistent with
33the federal Patient Protection and Affordable Care Act (Public
34Law 111-148), as amended by the federal Health Care and
35Education Reconciliation Act of 2010 (Public Law 111-152), and
36any additional federal guidance or regulations issued by the United
37States Secretary of Health and Human Services.

38(ii)  The health care service plan shall provide written notice
39stating that a dependent described in clause (i) who has not attained
4026 years of age is eligible to enroll in the plan for coverage. This
P40   1notice may be provided to the dependent’s parent on behalf of the
2dependent. If the notice is included with other enrollment materials
3for a group plan, the notice shall be prominent.

4(iii) In the case of an individual who enrolls under this
5subparagraph, coverage shall take effect no later than the first day
6of the first plan year beginning on or after September 23, 2010.

7(iv) A dependent enrolling in a group health plan for coverage
8pursuant to this subparagraph shall be treated as a special enrollee
9as provided under the rules of Section 146.117(d) of Title 45 of
10the Code of Federal Regulations. The health care service plan shall
11offer the recipient of the notice all of the benefit packages available
12to similarly situated individuals who did not lose coverage by
13reason of cessation of dependent status. Any difference in benefits
14or cost-sharing requirements shall constitute a different benefit
15package. A dependent enrolling in a group health plan for coverage
16pursuant to this subparagraph shall not be required to pay more
17for coverage than similarly situated individuals who did not lose
18coverage by reason of cessation of dependent status.

19(D) Nothing in this section shall require a health care service
20plan to make coverage available for a child of a child receiving
21dependent coverage. Nothing in this section shall be construed to
22modify the definition of “dependent” as used in the Revenue and
23Taxation Code with respect to the tax treatment of the cost of
24coverage.

25(e) A plan contract that provides coverage, whether by specific
26benefit or by the effect of general wording, for both an employee
27and one or more covered persons dependent upon the employee
28and provides for an extension of the coverage for any period
29following a termination of employment of the employee shall also
30provide that this extension of coverage shall apply to dependents
31upon the same terms and conditions precedent as applied to the
32covered employee, for the same period of time, subject to payment
33of premiums, if any, as required by the terms of the policy and
34subject to any applicable collective bargaining agreement.

35(f) A group contract shall not discriminate against handicapped
36persons or against groups containing handicapped persons. Nothing
37in this subdivision shall preclude reasonable provisions in a plan
38contract against liability for services or reimbursement of the
39handicap condition or conditions relating thereto, as may be
40allowed by rules of the director.

P41   1(g) Every group contract shall set forth the terms and conditions
2under which subscribers and enrollees may remain in the plan in
3the event the group ceases to exist, the group contract is terminated,
4or an individual subscriber leaves the group, or the enrollees’
5eligibility status changes.

6(h) (1) A health care service plan or specialized health care
7service plan may provide for coverage of, or for payment for,
8professional mental health services, or vision care services, or for
9the exclusion of these services. If the terms and conditions include
10coverage for services provided in a general acute care hospital or
11an acute psychiatric hospital as defined in Section 1250 and do
12not restrict or modify the choice of providers, the coverage shall
13extend to care provided by a psychiatric health facility as defined
14in Section 1250.2 operating pursuant to licensure by the State
15Department of Health Care Services. A health care service plan
16that offers outpatient mental health services but does not cover
17these services in all of its group contracts shall communicate to
18 prospective group contractholders as to the availability of outpatient
19coverage for the treatment of mental or nervous disorders.

20(2) No plan shall prohibit the member from selecting any
21psychologist who is licensed pursuant to the Psychology Licensing
22Law (Chapter 6.6 (commencing with Section 2900) of Division 2
23of the Business and Professions Code), any optometrist who is the
24holder of a certificate issued pursuant to Chapter 7 (commencing
25with Section 3000) of Division 2 of the Business and Professions
26Code or, upon referral by a physician and surgeon licensed pursuant
27to the Medical Practice Act (Chapter 5 (commencing with Section
282000) of Division 2 of the Business and Professions Code), (A)
29any marriage and family therapist who is the holder of a license
30under Section 4980.50 of the Business and Professions Code, (B)
31any licensed clinical social worker who is the holder of a license
32under Section 4996 of the Business and Professions Code, (C) any
33registered nurse licensed pursuant to Chapter 6 (commencing with
34Section 2700) of Division 2 of the Business and Professions Code,
35who possesses a master’s degree in psychiatric-mental health
36nursing and is listed as a psychiatric-mental health nurse by the
37Board of Registered Nursing, (D) any advanced practice registered
38nurse certified as a clinical nurse specialist pursuant to Article 9
39(commencing with Section 2838) of Chapter 6 of Division 2 of
40the Business and Professions Code who participates in expert
P42   1clinical practice in the specialty of psychiatric-mental health
2nursing, to perform the particular services covered under the terms
3of the plan, and the certificate holder is expressly authorized by
4law to perform these services, or (E) any professional clinical
5counselor who is the holder of a license under Chapter 16
6(commencing with Section 4999.10) of Division 2 of the Business
7and Professions Code.

8(3) Nothing in this section shall be construed to allow any
9certificate holder or licensee enumerated in this section to perform
10professional mental health services beyond his or her field or fields
11of competence as established by his or her education, training, and
12experience.

13(4) For the purposes of this section:

14(A) “Marriage and family therapist” means a licensed marriage
15and family therapist who has received specific instruction in
16assessment, diagnosis, prognosis, and counseling, and
17psychotherapeutic treatment of premarital, marriage, family, and
18child relationship dysfunctions, which is equivalent to the
19instruction required for licensure on January 1, 1981.

20(B) “Professional clinical counselor” means a licensed
21professional clinical counselor who has received specific
22instruction in assessment, diagnosis, prognosis, counseling, and
23 psychotherapeutic treatment of mental and emotional disorders,
24which is equivalent to the instruction required for licensure on
25January 1, 2012.

26(5) Nothing in this section shall be construed to allow a member
27to select and obtain mental health or psychological or vision care
28services from a certificate holder or licenseholder who is not
29directly affiliated with or under contract to the health care service
30plan or specialized health care service plan to which the member
31belongs. All health care service plans and individual practice
32associations that offer mental health benefits shall make reasonable
33efforts to make available to their members the services of licensed
34psychologists. However, a failure of a plan or association to comply
35with the requirements of the preceding sentence shall not constitute
36a misdemeanor.

37(6) As used in this subdivision, “individual practice association”
38means an entity as defined in subsection (5) of Section 1307 of
39the federal Public Health Service Act (42 U.S.C. Sec. 300e-1(5)).

P43   1(7) Health care service plan coverage for professional mental
2health services may include community residential treatment
3services that are alternatives to inpatient care and that are directly
4affiliated with the plan or to which enrollees are referred by
5providers affiliated with the plan.

6(i) If the plan utilizes arbitration to settle disputes, the plan
7contracts shall set forth the type of disputes subject to arbitration,
8the process to be utilized, and how it is to be initiated.

9(j) A plan contract that provides benefits that accrue after a
10certain time of confinement in a health care facility shall specify
11what constitutes a day of confinement or the number of consecutive
12 hours of confinement that are requisite to the commencement of
13benefits.

14(k) If a plan provides coverage for a dependent child who is
15over 26 years of age and enrolled as a full-time student at a
16secondary or postsecondary educational institution, the following
17shall apply:

18(1) Any break in the school calendar shall not disqualify the
19dependent child from coverage.

20(2) If the dependent child takes a medical leave of absence, and
21the nature of the dependent child’s injury, illness, or condition
22would render the dependent child incapable of self-sustaining
23employment, the provisions of subdivision (d) shall apply if the
24dependent child is chiefly dependent on the subscriber for support
25and maintenance.

26(3) (A) If the dependent child takes a medical leave of absence
27from school, but the nature of the dependent child’s injury, illness,
28or condition does not meet the requirements of paragraph (2), the
29dependent child’s coverage shall not terminate for a period not to
30exceed 12 months or until the date on which the coverage is
31scheduled to terminate pursuant to the terms and conditions of the
32plan, whichever comes first. The period of coverage under this
33paragraph shall commence on the first day of the medical leave of
34absence from the school or on the date the physician and surgeon
35determines the illness prevented the dependent child from attending
36school, whichever comes first. Any break in the school calendar
37shall not disqualify the dependent child from coverage under this
38paragraph.

39(B) Documentation or certification of the medical necessity for
40a leave of absence from school shall be submitted to the plan at
P44   1least 30 days prior to the medical leave of absence from the school,
2if the medical reason for the absence and the absence are
3foreseeable, or 30 days after the start date of the medical leave of
4absence from school and shall be considered prima facie evidence
5of entitlement to coverage under this paragraph.

6(4) This subdivision shall not apply to a specialized health care
7service plan or to a Medicare supplement plan.

8

SEC. 15.  

Section 104151 is added to the Health and Safety
9Code
, to read:

10

104151.  

Notwithstanding Section 10231.5 of the Government
11Code, each year, by no later than January 10 and concurrently with
12the release of the May Revision, the State Department of Health
13Care Services shall provide the fiscal committees of the Legislature
14with an estimate package for the Every Woman Counts Program.
15This estimate package shall include all significant assumptions
16underlying the estimate for the Every Woman Counts Program’s
17current-year and budget-year proposals, and shall contain concise
18information identifying applicable estimate components, such as
19caseload; a breakout of costs, including, but not limited to, clinical
20service activities, including office visits and consults, screening
21mammograms, diagnostic mammograms, diagnostic breast
22procedures, case management, and other clinical services; policy
23changes; contractor information; General Fund, special fund, and
24federal fund information; and other assumptions necessary to
25support the estimate.

26

SEC. 16.  

Section 111792 of the Health and Safety Code is
27amended to read:

28

111792.  

(a) The manufacturer of any cosmetic product subject
29to regulation by the federal Food and Drug Administration that is
30sold in this state shall, on a schedule and in electronic or other
31format, as determined by the division, provide the division with a
32complete and accurate list of its cosmetic products that, as of the
33date of submission, are sold in the state and that contain any
34ingredient that is a chemical identified as causing cancer or
35reproductive toxicity, including any chemical that meets either of
36the following conditions:

37(1) A chemical contained in the product for purposes of
38fragrance or flavoring.

39(2) A chemical identified by the phrase “and other ingredients”
40and determined to be a trade secret pursuant to the procedure
P45   1established in Part 20 and Section 720.8 of Part 720 of Title 21 of
2the Code of Federal Regulations. Any ingredient identified pursuant
3to this paragraph shall be considered to be a trade secret and shall
4be treated by the division in a manner consistent with the
5requirements of Part 20 and Part 720 of Title 21 of the Code of
6Federal Regulations. Any ingredients considered to be a trade
7secret shall not be subject to the California Public Records Act
8(Chapter 3.5 (commencing with Section 6250) of Division 7 of
9Title 1 of the Government Code) for the purposes of this section.

10(b) Any information submitted pursuant to subdivision (a) shall
11identify each chemical both by name and Chemical Abstract
12Service number and shall specify the product or products in which
13the chemical is contained.

14(c) If an ingredient identified pursuant to this section
15subsequently is removed from the product in which it was
16contained, is removed from the list of chemicals known to cause
17cancer or reproductive toxicity published under Section 25249.8,
18or is no longer a chemical identified as causing cancer or
19reproductive toxicity by an authoritative body, the manufacturer
20of the product containing the ingredient shall submit the new
21information to the division. Upon receipt of new information, the
22division, after verifying the accuracy of that information, shall
23revise the manufacturer’s information on record with the division
24to reflect the new information. The manufacturer shall not be under
25obligation to submit subsequent information on the presence of
26the ingredient in the product unless subsequent changes require
27submittal of the information.

28(d) This section shall not apply to any manufacturer of cosmetic
29products with annual aggregate sales of cosmetic products, both
30within and outside of California, of less than one million dollars
31($1,000,000), based on the manufacturer’s most recent tax year
32filing.

33(e) On or before December 31, 2013, the State Department of
34Public Health shall develop and make operational a
35consumer-friendly, public Internet Web site that creates a database
36of the information collected pursuant to this section. The database
37shall be searchable to accommodate a wide range of users,
38including users with limited technical and scientific literacy. Data
39shall be presented in an educational manner with, among other
40things, hypertext links that explain the meanings of technical terms,
P46   1including, but not limited to, “carcinogenic” and “reproductive
2toxicity.” The Internet Web site shall be designed to be easily
3navigable and to enable users to compare and contrast products
4and reportable ingredients. The Internet Web site shall include
5hypertext links to other educational and informational Internet
6Web sites to enhance consumer understanding.

7

SEC. 17.  

Section 123870 of the Health and Safety Code is
8amended to read:

9

123870.  

(a) The department shall establish standards of
10financial eligibility for treatment services under the California
11Children’s Services Program (CCS program).

12(1) Financial eligibility for treatment services under this program
13shall be limited to persons in families with an adjusted gross
14income of forty thousand dollars ($40,000) or less in the most
15recent tax year, as calculated for California state income tax
16purposes. If a person is enrolled in the Healthy Families Program
17(Part 6.2 (commencing with Section 12693) of Division 2 of the
18Insurance Code), the financial documentation required for that
19program in Section 2699.6600 of Title 10 of the California Code
20of Regulations may be used instead of the person’s California state
21income tax return. If a person is enrolled in the Medi-Cal program
22pursuant to Section 14005.26 of the Welfare and Institutions Code,
23or enrolled in the AIM-Linked Infants Program pursuant to Chapter
242 (commencing with Section 15850) of Part 3.3 of Division 9 of
25the Welfare and Institutions Code, the financial documentation
26required to establish eligibility for the respective programs may
27be used instead of the person’s California state income tax return.
28However, the director may authorize treatment services for persons
29in families with higher incomes if the estimated cost of care to the
30family in one year is expected to exceed 20 percent of the family’s
31adjusted gross income.

32(2) Children enrolled in the Healthy Families Program, the
33Medi-Cal program pursuant to Section 14005.26 of the Welfare
34and Institutions Code, or the AIM-Linked Infants Program pursuant
35to Chapter 2 (commencing with Section 15850) of Part 3.3 of
36Division 9 of the Welfare and Institutions Code, who have a CCS
37program eligible medical condition under Section 123830, and
38whose families do not meet the financial eligibility requirements
39of paragraph (1), shall be deemed financially eligible for CCS
40program benefits.

P47   1(b) Necessary medical therapy treatment services under the
2California Children’s Services Program rendered in the public
3schools shall be exempt from financial eligibility standards and
4enrollment fee requirements for the services when rendered to any
5handicapped child whose educational or physical development
6would be impeded without the services.

7(c) All counties shall use the uniform standards for financial
8eligibility and enrollment fees established by the department. All
9enrollment fees shall be used in support of the California Children’s
10Services Program.

11(d) Annually, every family with a child eligible to receive
12services under this article shall pay a fee of twenty dollars ($20),
13that shall be in addition to any other program fees for which the
14family is liable. This assessment shall not apply to any child who
15is eligible for full scope Medi-Cal benefits without a share of cost,
16for children receiving therapy through the California Children’s
17Services Program as a related service in their individualized
18education plans, for children from families having incomes of less
19than 100 percent of the federal poverty level, or for children
20covered under the Healthy Families Program or the AIM-Linked
21Infants Program.

22

SEC. 18.  

Section 123929 of the Health and Safety Code is
23amended to read:

24

123929.  

(a) Except as otherwise provided in this section and
25Section 14133.05 of the Welfare and Institutions Code, California
26Children’s Services Program services provided pursuant to this
27article require prior authorization by the department or its designee.
28Prior authorization is contingent on determination by the
29department or its designee of all of the following:

30(1) The child receiving the services is confirmed to be medically
31eligible for the CCS program.

32(2) The provider of the services is approved in accordance with
33the standards of the CCS program.

34(3) The services authorized are medically necessary to treat the
35child’s CCS-eligible medical condition.

36(b) The department or its designee may approve a request for a
37treatment authorization that is otherwise in conformance with
38subdivision (a) for services for a child participating in the Healthy
39Families Program or the AIM-Linked Infants Program pursuant
40to clause (ii) of subparagraph (A) of paragraph (6) of subdivision
P48   1(a) of Section 12693.70 of the Insurance Code or Chapter 2
2(commencing with Section 15850) of Part 3.3 of Division 9 of the
3Welfare and Institutions Code, received by the department or its
4designee after the requested treatment has been provided to the
5child.

6(c) If a provider of services who meets the requirements of
7paragraph (2) of subdivision (a) incurs costs for services described
8in paragraph (3) of subdivision (a) to treat a child described in
9subdivision (b) who is subsequently determined to be medically
10eligible for the CCS program as determined by the department or
11its designee, the department may reimburse the provider for those
12costs. Reimbursement under this section shall conform to the
13requirements of Section 14105.18 of the Welfare and Institutions
14Code.

15

SEC. 19.  

Section 123940 of the Health and Safety Code is
16amended to read:

17

123940.  

(a) (1) Annually, the board of supervisors shall
18appropriate a sum of money for services for handicapped children
19of the county, including diagnosis, treatment, and therapy services
20for physically handicapped children in public schools, equal to 25
21percent of the actual expenditures for the county program under
22this article for the 1990-91 fiscal year, except as specified in
23paragraph (2).

24(2) If the state certifies that a smaller amount is needed in order
25for the county to pay 25 percent of costs of the county’s program
26from this source. The smaller amount certified by the state shall
27be the amount that the county shall appropriate.

28(b) In addition to the amount required by subdivision (a), the
29county shall allocate an amount equal to the amount determined
30pursuant to subdivision (a) for purposes of this article from
31revenues allocated to the county pursuant to Chapter 6
32(commencing with Section 17600) of Division 9 of the Welfare
33and Institutions Code.

34(c) (1) The state shall match county expenditures for this article
35from funding provided pursuant to subdivisions (a) and (b).

36(2) County expenditures shall be waived for payment of services
37for children who are eligible pursuant to paragraph (2) of
38subdivision (a) of Section 123870.

39(d) The county may appropriate and expend moneys in addition
40to those set forth in subdivision (a) and (b) and the state shall match
P49   1the expenditures, on a dollar-for-dollar basis, to the extent that
2state funds are available for this article.

3(e) County appropriations under subdivisions (a) and (b) shall
4include county financial participation in the nonfederal share of
5expenditures for services for children who are enrolled in the
6Medi-Cal program pursuant to Section 14005.26 of the Welfare
7and Institutions Code, or the AIM-Linked Infants Program pursuant
8to Chapter 2 (commencing with Section 15850) of Part 3.3 of
9Division 9 of the Welfare and Institutions Code, and who are
10eligible for services under this article pursuant to paragraph (1) of
11subdivision (a) of Section 123870, to the extent that federal
12financial participation is available at the enhanced federal
13reimbursement rate under Title XXI of the federal Social Security
14Act (42 U.S.C. Sec. 1397aa et seq.) and funds are appropriated for
15the California Children’s Services Program in the State Budget.

16(f) Nothing in this section shall require the county to expend
17more than the amount set forth in subdivision (a) plus the amount
18set forth in subdivision (b) nor shall it require the state to expend
19more than the amount of the match set forth in subdivision (c).

20(g) Notwithstanding Chapter 3.5 (commencing with Section
2111340) of Part 1 of Division 3 of Title 2 of the Government Code,
22the department, without taking further regulatory action, shall
23implement this section by means of California Children’s Services
24numbered letters.

25

SEC. 20.  

Section 123955 of the Health and Safety Code is
26amended to read:

27

123955.  

(a) The state and the counties shall share in the cost
28of administration of the California Children’s Services Program
29at the local level.

30(b) (1) The director shall adopt regulations establishing
31minimum standards for the administration, staffing, and local
32implementation of this article subject to reimbursement by the
33state.

34(2) The standards shall allow necessary flexibility in the
35administration of county programs, taking into account the
36variability of county needs and resources, and shall be developed
37and revised jointly with state and county representatives.

38(c) The director shall establish minimum standards for
39administration, staffing and local operation of the program subject
40to reimbursement by the state.

P50   1(d) Until July 1, 1992, reimbursable administrative costs, to be
2paid by the state to counties, shall not exceed 4.1 percent of the
3gross total expenditures for diagnosis, treatment and therapy by
4counties as specified in Section 123940.

5(e) Beginning July 1, 1992, this subdivision shall apply with
6respect to all of the following:

7(1) Counties shall be reimbursed by the state for 50 percent of
8the amount required to meet state administrative standards for that
9portion of the county caseload under this article that is ineligible
10for Medi-Cal to the extent funds are available in the State Budget
11for the California Children’s Services Program.

12(2) Counties shall be reimbursed by the state for 50 percent of
13the nonfederal share of the amount required to meet state
14administrative standards for that portion of the county caseload
15under this article that is enrolled in the Medi-Cal program pursuant
16to Section 14005.26 of the Welfare and Institutions Code or the
17AIM-Linked Infants Program pursuant to Chapter 2 (commencing
18with Section 15850) of Part 3.3 of Division 9 of the Welfare and
19Institutions Code, and who are eligible for services under this
20article pursuant to subdivision (a) of Section 123870, to the extent
21that federal financial participation is available at the enhanced
22federal reimbursement rate under Title XXI of the federal Social
23Security Act (42 U.S.C. Sec. 1397aa et seq.) and funds are
24appropriated for the California Children’s Services Program in the
25State Budget.

26(3) On or before September 15 of each year, each county
27program implementing this article shall submit an application for
28the subsequent fiscal year that provides information as required
29by the state to determine if the county administrative staff and
30budget meet state standards.

31(4) The state shall determine the maximum amount of state
32funds available for each county from state funds appropriated for
33CCS county administration. If the amount appropriated for any
34fiscal year in the Budget Act for county administration under this
35article differs from the amounts approved by the department, each
36county shall submit a revised application in a form and at the time
37specified by the department.

38(f) The department and counties shall maximize the use of
39federal funds for administration of the programs implemented
40pursuant to this article, including using state and county funds to
P51   1match funds claimable under Title XIX or Title XXI of the federal
2Social Security Act (42 U.S.C. Sec. 1396 et seq.; 42 U.S.C. Sec.
31397aa et seq.).

4

SEC. 21.  

Section 10125 of the Insurance Code is amended to
5read:

6

10125.  

(a) On and after January 1, 1974, every insurer issuing
7group disability insurance which covers hospital, medical, or
8surgical expenses shall offer coverage for expenses incurred as a
9result of mental or nervous disorders, under the terms and
10conditions which may be agreed upon between the group
11policyholder and the insurer. If the terms and conditions include
12coverage for inpatient care for nervous or mental disorders, the
13coverage shall extend to treatment provided at all of the following
14facilities:

15(1) A general acute care hospital as defined in subdivision (a)
16of Section 1250 of the Health and Safety Code.

17(2) An acute psychiatric hospital as defined in subdivision (b)
18of Section 1250 of the Health and Safety Code.

19(3) A psychiatric health facility as defined by Section 1250.2
20of the Health and Safety Code operating pursuant to licensure by
21the State Department of Health Care Services.

22Nothing in this subdivision prohibits an insurer that negotiates
23and enters into a contract with a professional or institutional
24provider for alternative rates of payment pursuant to Section 10133
25from restricting or modifying the choice of providers.

26(b) Every insurer shall communicate to prospective group
27policyholders as to the availability of outpatient coverage for the
28treatment of mental or nervous disorders. Every insurer shall
29communicate the availability of that coverage to all group
30policyholders and to all prospective group policyholders with
31whom they are negotiating. This coverage may include community
32residential treatment services, as described in former Section 5458
33of the Welfare and Institutions Code, that are alternatives to
34institutional care.

35

SEC. 22.  

Section 10127 of the Insurance Code is amended to
36read:

37

10127.  

On and after January 1, 1974, every self-insured
38employee welfare benefit plan that provides coverage for hospital,
39medical, or surgical expenses shall offer coverage for expenses
40incurred as a result of mental or nervous disorders, under the terms
P52   1and conditions which may be agreed upon between the self-insured
2welfare benefit plan and the member. If the terms and conditions
3include coverage for services provided in a general acute care
4hospital, or an acute psychiatric hospital as defined in Section 1250
5of the Health and Safety Code, and do not restrict or modify the
6choice of providers, the coverage shall extend to care provided by
7a psychiatric health facility, as defined by Section 1250.2 of the
8Health and Safety Code, operating pursuant to licensure by the
9State Department of Health Care Services. Every plan shall
10communicate to prospective members as to the availability of
11outpatient coverage for the treatment of mental or nervous
12disorders. Every self-insured welfare benefit plan shall
13communicate the availability of this coverage to all members and
14prospective members. This coverage may include community
15residential treatment services, as described in former Section 5458
16of the Welfare and Institutions Code, that are alternatives to
17institutional care.

18

SEC. 23.  

Section 12693.70 of the Insurance Code is amended
19to read:

20

12693.70.  

To be eligible to participate in the program, an
21applicant shall meet all of the following requirements:

22(a) Be an applicant applying on behalf of an eligible child, which
23means a child who is all of the following:

24(1) Less than 19 years of age. An application may be made on
25behalf of a child not yet born up to three months prior to the
26expected date of delivery. Coverage shall begin as soon as
27administratively feasible, as determined by the board, after the
28board receives notification of the birth. However, no child less
29than 12 months of age shall be eligible for coverage until 90 days
30after the enactment of the Budget Act of 1999.

31(2) Not eligible for no-cost full-scope Medi-Cal or Medicare
32coverage at the time of application.

33(3) In compliance with Sections 12693.71 and 12693.72.

34(4) A child who meets citizenship and immigration status
35requirements that are applicable to persons participating in the
36program established by Title XXI of the Social Security Act, except
37as specified in Section 12693.76.

38(5) A resident of the State of California pursuant to Section 244
39of the Government Code; or, if not a resident pursuant to Section
40244 of the Government Code, is physically present in California
P53   1and entered the state with a job commitment or to seek
2employment, whether or not employed at the time of application
3to or after acceptance in, the program.

4(6) (A) In either of the following:

5(i) In a family with an annual or monthly household income
6equal to or less than 200 percent of the federal poverty level.

7(ii) (I) When implemented by the board, subject to subdivision
8(b) of Section 12693.765 and pursuant to this section, a child under
9the age of two years who was delivered by a mother enrolled in
10the Access for Infants and Mothers Program as described in Part
116.3 (commencing with Section 12695). Commencing July 1, 2007,
12eligibility under this subparagraph shall not include infants during
13any time they are enrolled in employer-sponsored health insurance
14or are subject to an exclusion pursuant to Section 12693.71 or
1512693.72, or are enrolled in the full scope of benefits under the
16Medi-Cal program at no share of cost. For purposes of this clause,
17any infant born to a woman whose enrollment in the Access for
18Infants and Mothers Program begins after June 30, 2004, shall be
19automatically enrolled in the Healthy Families Program, except
20during any time on or after July 1, 2007, that the infant is enrolled
21in employer-sponsored health insurance or is subject to an
22exclusion pursuant to Section 12693.71 or 12693.72, or is enrolled
23in the full scope of benefits under the Medi-Cal program at no
24share of cost. Except as otherwise specified in this section, this
25enrollment shall cover the first 12 months of the infant’s life. At
26the end of the 12 months, as a condition of continued eligibility,
27the applicant shall provide income information. The infant shall
28be disenrolled if the gross annual household income exceeds the
29 income eligibility standard that was in effect in the Access for
30Infants and Mothers Program at the time the infant’s mother
31became eligible, or following the two-month period established
32in Section 12693.981 if the infant is eligible for Medi-Cal with no
33share of cost. At the end of the second year, infants shall again be
34screened for program eligibility pursuant to this section, with
35income eligibility evaluated pursuant to clause (i), subparagraphs
36(B) and (C), and paragraph (2) of subdivision (a).

37(II) Effective on October 1, 2013, or when the State Department
38of Health Care Services has implemented Chapter 2 (commencing
39with Section 15850) of Part 3.3 of Division 9 of the Welfare and
40Institutions Code, whichever is later, eligibility for coverage in
P54   1the program pursuant to this clause shall terminate. The board shall
2 coordinate with the State Department of Health Care Services to
3implement Chapter 2 (commencing with Section 15850) of Part
43.3 of Division 9 of the Welfare and Institutions Code, including
5transition of subscribers to the AIM-Linked Infants Program. The
6State Department of Health Care Services shall administer the
7AIM-Linked Infants Program, pursuant to Chapter 2 (commencing
8with Section 15850) of Part 3.3 of Division 9 of the Welfare and
9Institutions Code, to address the health care needs of children
10formerly covered pursuant to this clause.

11(B) All income over 200 percent of the federal poverty level
12but less than or equal to 250 percent of the federal poverty level
13shall be disregarded in calculating annual or monthly household
14income.

15(C) In a family with an annual or monthly household income
16greater than 250 percent of the federal poverty level, any income
17deduction that is applicable to a child under Medi-Cal shall be
18applied in determining the annual or monthly household income.
19If the income deductions reduce the annual or monthly household
20income to 250 percent or less of the federal poverty level,
21subparagraph (B) shall be applied.

22(b) The applicant shall agree to remain in the program for six
23months, unless other coverage is obtained and proof of the coverage
24is provided to the program.

25(c) An applicant shall enroll all of the applicant’s eligible
26children in the program.

27(d) In filing documentation to meet program eligibility
28requirements, if the applicant’s income documentation cannot be
29provided, as defined in regulations promulgated by the board, the
30applicant’s signed statement as to the value or amount of income
31shall be deemed to constitute verification.

32(e) An applicant shall pay in full any family contributions owed
33in arrears for any health, dental, or vision coverage provided by
34the program within the prior 12 months.

35(f) By January 2008, the board, in consultation with
36stakeholders, shall implement processes by which applicants for
37subscribers may certify income at the time of annual eligibility
38review, including rules concerning which applicants shall be
39permitted to certify income and the circumstances in which
40supplemental information or documentation may be required. The
P55   1board may terminate using these processes not sooner than 90 days
2after providing notification to the Chair of the Joint Legislative
3Budget Committee. This notification shall articulate the specific
4reasons for the termination and shall include all relevant data
5elements that are applicable to document the reasons for the
6termination. Upon the request of the Chair of the Joint Legislative
7Budget Committee, the board shall promptly provide any additional
8clarifying information regarding implementation of the processes
9required by this subdivision.

10

SEC. 24.  

Section 12698 of the Insurance Code is amended to
11read:

12

12698.  

To be eligible to participate in the program, a person
13shall meet all of the following requirements:

14(a) Be a resident of the state. A person who is a member of a
15federally recognized California Indian tribe is a resident of the
16state for these purposes.

17(b) (1) Until the first day of the second month following the
18effective date of the amendment made to this subdivision in 1994,
19have a household income that does not exceed 250 percent of the
20official federal poverty level unless the board determines that the
21program funds are adequate to serve households above that level.

22(2) Upon the first day of the second month following the
23effective date of the amendment made to this subdivision in 1994,
24have a household income that is above 200 percent of the official
25federal poverty level but does not exceed 250 percent of the official
26federal poverty level unless the board determines that the program
27funds are adequate to serve households above the 250 percent of
28the official federal poverty level.

29(c) Pay an initial subscriber contribution of not more than fifty
30dollars ($50), and agree to the payment of the complete subscriber
31contribution. A federally recognized California Indian tribal
32government may make the initial and complete subscriber
33contributions on behalf of a member of the tribe only if a
34contribution on behalf of members of federally recognized
35California Indian tribes does not limit or preclude federal financial
36participation under Title XXI of the Social Security Act. If a
37federally recognized California Indian tribal government makes a
38contribution on behalf of a member of the tribe, the tribal
39government shall ensure that the subscriber is made aware of all
P56   1the health plan options available in the county where the member
2resides.

3(d) Effective January 1, 2014, when determining eligibility for
4benefits under the program, income shall be determined, counted,
5and valued in accordance with the requirements of Section
61397bb(b)(1)(B) of Title 42 of the United States Code as added
7by the federal Patient Protection and Affordable Care Act (Public
8Law 111-148) and as amended by the federal Health Care and
9Education Reconciliation Act of 2010 (Public Law 111-152) and
10any subsequent amendments.

11

SEC. 25.  

Section 12737 of the Insurance Code is amended to
12read:

13

12737.  

(a) The board shall establish program contribution
14amounts for each category of risk for each participating health
15plan. The program contribution amounts shall be based on the
16average amount of subsidy funds required for the program as a
17whole. To determine the average amount of subsidy funds required,
18the board shall calculate a loss ratio, including all medical costs,
19administration fees, and risk payments, for the program in the prior
20calendar year. The loss ratio shall be calculated using 125 percent
21of the standard average individual rates for comparable coverage
22as the denominator, and all medical costs, administration fees, and
23risk payments as the numerator. The average amount of subsidy
24funds required is calculated by subtracting 100 percent from the
25program loss ratio. For purposes of calculating the program loss
26ratio, no participating health plan’s loss ratio shall be less than 100
27percent and participating health plans with fewer than 1,000
28program members shall be excluded from the calculation.

29Subscriber contributions shall be established to encourage
30members to select those health plans requiring subsidy funds at or
31below the program average subsidy. Subscriber contribution
32amounts shall be established so that no subscriber receives a
33subsidy greater than the program average subsidy, except that:

34(1) In all areas of the state, at least one plan shall be available
35to program participants at an average subscriber contribution of
36125 percent of the standard average individual rates for comparable
37coverage.

38(2) No subscriber contribution shall be increased by more than
3910 percent above 125 percent of the standard average individual
40rates for comparable coverage.

P57   1(3) Subscriber contributions for participating health plans joining
2the program after January 1, 1997, shall be established at 125
3percent of the standard average individual rates for comparable
4coverage for the first two benefit years the plan participates in the
5program.

6(b) The program shall pay program contribution amounts to
7participating health plans from the Major Risk Medical Insurance
8Fund.

9(c) Commencing January 1, 2013, in addition to the amount of
10subsidy funds required pursuant to subdivision (a), the program
11may further subsidize subscriber contributions so that the amount
12paid by each subscriber is below 125 percent of the standard
13average individual risk rate for comparable coverage but no less
14than 100 percent of the standard average individual risk rate for
15comparable coverage. For purposes of calculating premiums for
16the following products, any reference to, or use of, subscriber
17contributions, premiums, average premiums, or amounts paid by
18subscribers in the program shall be construed to mean subscriber
19contributions as described in subdivision (a) without application
20of the additional subsidies permitted by this subdivision:

21(1) Standard benefit plans pursuant to Section 10127.16 and
22Section 1373.622 of the Health and Safety Code.

23(2) Health benefit plans and health care service plan contracts
24for federally eligible defined individuals pursuant to Sections
2510901.3 and 10901.9 and Sections 1399.805 and 1399.811 of the
26Health and Safety Code.

27(3) Conversion coverage pursuant to Section 12682.1 and
28Section 1373.6 of the Health and Safety Code.

29

SEC. 26.  

Section 12739.61 of the Insurance Code is amended
30to read:

31

12739.61.  

The board shall cease to provide coverage through
32the program on July 1, 2013, except as required by the contract
33between the board and the United States Department of Health
34and Human Services, and at that time shall cease to operate the
35program except as required to complete payments to, or payment
36reconciliations with, participating health plans or other contractors,
37process appeals, or conduct other necessary termination activities.

38

SEC. 27.  

Section 359 of the Welfare and Institutions Code is
39amended to read:

P58   1

359.  

(a) Whenever a minor who appears to be a danger to
2himself or others as a result of the use of narcotics, as defined in
3Section 11019 of the Health and Safety Code, or a restricted
4dangerous drug (as defined in former Section 11901 of the Health
5and Safety Code), is brought before any judge of the juvenile court,
6the judge may continue the hearing and proceed pursuant to this
7section. The court may order the minor taken to a facility
8designated by the county and approved by the State Department
9of Health Care Services as a facility for 72-hour treatment and
10evaluation. Thereupon the provisions of Section 11922 of the
11Health and Safety Code shall apply, except that the professional
12person in charge of the facility shall make a written report to the
13court concerning the results of the evaluation of the minor.

14(b) If the professional person in charge of the facility for 72-hour
15evaluation and treatment reports to the juvenile court that the minor
16is not a danger to himself or others as a result of the use of narcotics
17or restricted dangerous drugs or that the minor does not require
1814-day intensive treatment, or if the minor has been certified for
19not more than 14 days of intensive treatment and the certification
20is terminated, the minor shall be released if the juvenile court
21proceedings have been dismissed; referred for further care and
22treatment on a voluntary basis, subject to the disposition of the
23juvenile court proceedings; or returned to the juvenile court, in
24which event the court shall proceed with the case pursuant to this
25chapter.

26(c) Any expenditure for the evaluation or intensive treatment
27of a minor under this section shall be considered an expenditure
28made under Part 2 (commencing with Section 5600) of Division
295, and shall be reimbursed by the state as are other local
30expenditures pursuant to that part.

31

SEC. 28.  

Section 708 of the Welfare and Institutions Code is
32amended to read:

33

708.  

(a) Whenever a minor who appears to be a danger to
34himself or herself or others as a result of the use of controlled
35substances (as defined in Division 10 (commencing with Section
3611000) of the Health and Safety Code), is brought before any judge
37of the juvenile court, the judge may continue the hearing and
38proceed pursuant to this section. The court may order the minor
39taken to a facility designated by the county and approved by the
40State Department of Health Care Services as a facility for 72-hour
P59   1treatment and evaluation. Thereupon the provisions of Section
25343 shall apply, except that the professional person in charge of
3the facility shall make a written report to the court concerning the
4results of the evaluation of the minor.

5(b) If the professional person in charge of the facility for 72-hour
6evaluation and treatment reports to the juvenile court that the minor
7is not a danger to himself or herself or others as a result of the use
8of controlled substances or that the minor does not require 14-day
9intensive treatment, or if the minor has been certified for not more
10than 14 days of intensive treatment and the certification is
11terminated, the minor shall be released if the juvenile court
12proceedings have been dismissed; referred for further care and
13treatment on a voluntary basis, subject to the disposition of the
14juvenile court proceedings; or returned to the juvenile court, in
15which event the court shall proceed with the case pursuant to this
16chapter.

17(c) Any expenditure for the evaluation or intensive treatment
18of a minor under this section shall be considered an expenditure
19made under Part 2 (commencing with Section 5600) of Division
205, and shall be reimbursed by the state as are other local
21expenditures pursuant to that part.

22

SEC. 29.  

Section 4005.7 of the Welfare and Institutions Code
23 is amended to read:

24

4005.7.  

All regulations heretofore adopted by the State
25Department of Mental Health, and its successor, pursuant to
26authority vested in the State Department of Health Care Services
27by Section 4005.1 and in effect immediately preceding the
28operative date of the act that amended this section in the first year
29of the 2013-14 Regular Session shall remain in effect and shall
30be fully enforceable unless and until readopted, amended, or
31repealed by the Director of Health Care Services.

32

SEC. 30.  

Section 4080 of the Welfare and Institutions Code is
33amended to read:

34

4080.  

(a) Psychiatric health facilities, as defined in Section
351250.2 of the Health and Safety Code, shall only be licensed by
36the State Department of Health Care Services subsequent to
37application by counties, county contract providers, or other
38organizations pursuant to this part.

39(b) (1) For counties or county contract providers that choose
40to apply, the local mental health director shall first present to the
P60   1local mental health advisory board for its review an explanation
2of the need for the facility and a description of the services to be
3provided. The local mental health director shall then submit to the
4governing body the explanation and description. The governing
5body, upon its approval, may submit the application to the State
6Department of Health Care Services.

7(2) Other organizations that will be applying for licensure and
8do not intend to use any Bronzan-McCorquodale funds pursuant
9to Section 5707 shall submit to the local mental health director
10and the governing body in the county in which the facility is to be
11located a written and dated proposal of the services to be provided.
12The local mental health director and governing body shall have
1330 days during which to provide any advice and recommendations
14regarding licensure, as they deem appropriate. At any time after
15the 30-day period, the organizations may then submit their
16applications, along with the mental health director’s and governing
17body’s advice and recommendations, if any, to the State
18Department of Health Care Services.

19(c) The State Fire Marshal and other appropriate state agencies,
20to the extent required by law, shall cooperate fully with the State
21Department of Health Care Services to ensure that the State
22Department of Health Care Services approves or disapproves the
23licensure applications not later than 90 days after the application
24submission by a county, county contract provider, or other
25organization.

26(d) Every psychiatric health facility and program for which a
27license has been issued shall be periodically inspected by a
28multidisciplinary team appointed or designated by the State
29Department of Health Care Services. The inspection shall be
30conducted no less than once every two years and as often as
31necessary to ensure the quality of care provided. During the
32inspections the review team shall offer such advice and assistance
33to the psychiatric health facility as it deems appropriate.

34(e) (1) The program aspects of a psychiatric health facility that
35shall be reviewed and may be approved by the State Department
36of Health Care Services shall include, but not be limited to:

37(A) Activities programs.

38(B) Administrative policies and procedures.

39(C) Admissions, including provisions for a mental evaluation.

40(D) Discharge planning.

P61   1(E) Health records content.

2(F) Health records services.

3(G) Interdisciplinary treatment teams.

4(H) Nursing services.

5(I) Patient rights.

6(J) Pharmaceutical services.

7(K) Program space requirements.

8(L) Psychiatrist and clinical psychological services.

9(M) Rehabilitation services.

10(N) Restraint and seclusion.

11(O) Social work services.

12(P) Space, supplies, and equipment.

13(Q) Staffing standards.

14(R) Unusual occurrences.

15(S) Use of outside resources, including agreements with general
16acute care hospitals.

17(T) Linguistic access and cultural competence.

18(U) Structured outpatient services to be provided under special
19permit.

20(2) The State Department of Health Care Services has the sole
21authority to grant program flexibility.

22(f) Commencing July 1, 2013, the State Department of Health
23Care Services may adopt regulations regarding psychiatric health
24facilities that shall include, but not be limited to, all of the
25following:

26(1) Procedures by which the State Department of Health Care
27Services shall review and may approve the program and facility
28requesting licensure as a psychiatric health facility as being in
29compliance with program standards established by the department.

30(2) Procedures by which the Director of Health Care Services
31shall approve, or deny approval of, the program and facility
32licensed as a psychiatric health facility pursuant to this section.

33(3) Provisions for site visits by the State Department of Health
34Care Services for the purpose of reviewing a facility’s compliance
35with program and facility standards.

36(4) Provisions for the State Department of Health Care Services
37for any administrative proceeding regarding denial, suspension,
38or revocation of a psychiatric health facility license.

P62   1(5) Procedures for the appeal of an administrative finding or
2action pursuant to paragraph (4) of this subdivision and subdivision
3(j).

4(g) Regulations may be adopted by the State Department of
5Health Care Services that establish standards for pharmaceutical
6services in psychiatric health facilities. Licensed psychiatric health
7facilities shall be exempt from requirements to obtain a separate
8pharmacy license or permit.

9(h) (1) It is the intent of the Legislature that the State
10Department of Health Care Services shall license the facility in
11order to establish innovative and more competitive and specialized
12acute care services.

13(2) The State Department of Health Care Services shall review
14and may approve the program aspects of public or private facilities,
15with the exception of those facilities that are federally certified or
16accredited by a nationally recognized commission that accredits
17health care facilities, only if the average per diem charges or costs
18of service provided in the facility is approximately 60 percent of
19the average per diem charges or costs of similar psychiatric services
20provided in a general hospital.

21(3) (A) When a private facility is accredited by a nationally
22recognized commission that accredits health care facilities, the
23State Department of Health Care Services shall review and may
24approve the program aspects only if the average per diem charges
25or costs of service provided in the facility do not exceed
26approximately 75 percent of the average per diem charges or costs
27of similar psychiatric service provided in a psychiatric or general
28hospital.

29(B) When a private facility serves county patients, the State
30Department of Health Care Services shall review and may approve
31the program aspects only if the facility is federally certified by the
32federal Centers for Medicare and Medicaid Services and serves a
33population mix that includes a proportion of Medi-Cal patients
34sufficient to project an overall cost savings to the county, and the
35average per diem charges or costs of service provided in the facility
36do not exceed approximately 75 percent of the average per diem
37charges or costs of similar psychiatric service provided in a
38psychiatric or general hospital.

39(4) When a public facility is federally certified by the federal
40Centers for Medicare and Medicaid Services and serves a
P63   1population mix that includes a proportion of Medi-Cal patients
2sufficient to project an overall program cost savings with
3certification, the State Department of Health Care Services shall
4approve the program aspects only if the average per diem charges
5or costs of service provided in the facility do not exceed
6approximately 75 percent of the average per diem charges or costs
7of similar psychiatric service provided in a psychiatric or general
8hospital.

9(5) (A) The State Department of Health Care Services may set
10a lower rate for private or public facilities than that required by
11paragraph (3) or (4), if so required by the federal Centers for
12Medicare and Medicaid Services as a condition for the receipt of
13federal matching funds.

14(B) This section does not impose any obligation on any private
15facility to contract with a county for the provision of services to
16Medi-Cal beneficiaries, and any contract for that purpose is subject
17to the agreement of the participating facility.

18(6) (A) In using the guidelines specified in this subdivision,
19the State Department of Health Care Services shall take into
20account local conditions affecting the costs or charges.

21(B) In those psychiatric health facilities authorized by special
22permit to offer structured outpatient services not exceeding 10
23daytime hours, the following limits on per diem rates shall apply:

24(i) The per diem charge for patients in both a morning and an
25afternoon program on the same day shall not exceed 60 percent of
26the facility’s authorized per diem charge for inpatient services.

27(ii) The per diem charge for patients in either a morning or
28afternoon program shall not exceed 30 percent of the facility’s
29authorized per diem charge for inpatient services.

30(i) The licensing fees charged for these facilities shall be credited
31to the State Department of Health Care Services for its costs
32incurred in the review of psychiatric health facility programs, in
33connection with the licensing of these facilities.

34(j) (1) The State Department of Health Care Services shall
35establish a system for the imposition of prompt and effective civil
36sanctions against psychiatric health facilities in violation of the
37laws and regulations of this state pertaining to psychiatric health
38facilities. If the State Department of Health Care Services
39determines that there is or has been a failure, in a substantial
40manner, on the part of a psychiatric health facility to comply with
P64   1the laws and regulations, the Director of Health Care Services may
2impose the following sanctions:

3(A) Cease and desist orders.

4(B) Monetary sanctions, which may be imposed in addition to
5the penalties of suspension, revocation, or cease and desist orders.
6The amount of monetary sanctions permitted to be imposed
7pursuant to this subparagraph shall not be less than fifty dollars
8($50) nor more than one hundred dollars ($100) multiplied by the
9licensed bed capacity, per day, for each violation. However, the
10monetary sanction shall not exceed three thousand dollars ($3,000)
11per day. A facility that is assessed a monetary sanction under this
12subparagraph, and that repeats the deficiency, may, in accordance
13with the regulations adopted pursuant to this subdivision, be subject
14to immediate suspension of its license until the deficiency is
15corrected.

16(2) The State Department of Health Care Services may adopt
17regulations necessary to implement this subdivision and paragraph
18(5) of subdivision (f) in accordance with the Administrative
19Procedure Act (Chapter 3.5 (commencing with Section 11340) of
20Part 1 of Division 3 of Title 2 of the Government Code).

21(k) Proposed changes in the standards or regulations affecting
22health facilities that serve the mentally disordered shall be effected
23only with the review and coordination of the California Health and
24Human Services Agency.

25(l) In psychiatric health facilities where the clinical director is
26not a physician, a psychiatrist, or if one is temporarily not available,
27a physician shall be designated who shall direct those medical
28treatments and services that can only be provided by, or under the
29direction of, a physician.

30

SEC. 31.  

Section 5150 of the Welfare and Institutions Code is
31amended to read:

32

5150.  

(a) When any person, as a result of mental disorder, is
33a danger to others, or to himself or herself, or gravely disabled, a
34peace officer, member of the attending staff, as defined by
35regulation, of an evaluation facility designated by the county, or
36other professional person designated by the county may, upon
37probable cause, take, or cause to be taken, the person into custody
38and place him or her in a facility designated by the county and
39approved by the State Department of Health Care Services as a
40facility for 72-hour treatment and evaluation.

P65   1(b) The facility shall require an application in writing stating
2the circumstances under which the person’s condition was called
3to the attention of the officer, member of the attending staff, or
4professional person, and stating that the officer, member of the
5attending staff, or professional person has probable cause to believe
6that the person is, as a result of mental disorder, a danger to others,
7or to himself or herself, or gravely disabled. If the probable cause
8is based on the statement of a person other than the officer, member
9of the attending staff, or professional person, the person shall be
10liable in a civil action for intentionally giving a statement which
11he or she knows to be false.

12

SEC. 32.  

Section 5151 of the Welfare and Institutions Code is
13amended to read:

14

5151.  

(a) If the facility for 72-hour treatment and evaluation
15admits the person, it may detain him or her for evaluation and
16treatment for a period not to exceed 72 hours. Saturdays, Sundays,
17and holidays may be excluded from the 72-hour period if the State
18Department of Health Care Services certifies for each facility that
19evaluation and treatment services cannot reasonably be made
20available on those days. The certification by the department is
21subject to renewal every two years. The department may adopt
22regulations defining criteria for determining whether a facility can
23reasonably be expected to make evaluation and treatment services
24available on Saturdays, Sundays, and holidays.

25(b) Prior to admitting a person to the facility for 72-hour
26treatment and evaluation pursuant to Section 5150, the professional
27person in charge of the facility or his or her designee shall assess
28the individual in person to determine the appropriateness of the
29involuntary detention.

30(c) If in the judgment of the professional person in charge of
31the facility providing evaluation and treatment, or his or her
32designee, the person can be properly served without being detained,
33he or she shall be provided evaluation, crisis intervention, or other
34inpatient or outpatient services on a voluntary basis.

35(d) Nothing in this section shall be interpreted to prevent a peace
36officer from delivering individuals to a designated facility for
37assessment under Section 5150. Furthermore, the preadmission
38assessment requirement of this section shall not be interpreted to
39require peace officers to perform any additional duties other than
40those specified in Sections 5150.1 and 5150.2.

P66   1

SEC. 33.  

Section 5157 of the Welfare and Institutions Code is
2amended to read:

3

5157.  

(a) Each person, at the time he or she is first taken into
4custody under provisions of Section 5150, shall be provided, by
5the person who takes such other person into custody, the following
6information orally. The information shall be in substantially the
7following form:

 

My name is    .

I am a     .

(peace officer, mental health professional)

with     .

(name of agency)

You are not under criminal arrest, but I am taking you for examination by mental health professionals at     .

   

(name of facility)

You will be told your rights by the mental health staff.

 If taken into custody at his or her residence, the person shall also be told the following information in substantially the following form:

 You may bring a few personal items with you which I will have to approve. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken.

P66  24

 

25(b) The designated facility shall keep, for each patient evaluated,
26a record of the advisement given pursuant to subdivision (a) which
27shall include:

28(1) Name of person detained for evaluation.

29(2) Name and position of peace officer or mental health
30professional taking person into custody.

31(3) Date.

32(4) Whether advisement was completed.

33(5) If not given or completed, the mental health professional at
34the facility shall either provide the information specified in
35subdivision (a), or include a statement of good cause, as defined
36by regulations of the State Department of Health Care Services,
37which shall be kept with the patient’s medical record.

38(c) Each person admitted to a designated facility for 72-hour
39evaluation and treatment shall be given the following information
40by admission staff at the evaluation unit. The information shall be
P67   1given orally and in writing and in a language or modality accessible
2to the person. The written information shall be available in the
3person’s native language or the language which is the person’s
4principal means of communication. The information shall be in
5substantially the following form:

 

My name is    .

My position here is    .

 You are being placed into the psychiatric unit because it is our professional opinion that as a result of mental disorder, you are likely to:

 (check applicable)
  harm yourself ____
  harm someone else ____
  be unable to take care of your own
   food, clothing, and housing needs ____
We feel this is true because

   

(herewith a listing of the facts upon which the allegation of dangerous
or gravely disabled due to mental disorder is based, including pertinent
facts arising from the admission interview.)

 You will be held on the ward for a period up to 72 hours.
 This does not include weekends or holidays.

Your 72-hour period will begin    

(day and time.)

 During these 72 hours you will be evaluated by the hospital staff, and you may be given treatment, including medications. It is possible for you to be released before the end of the 72 hours. But if the staff decides that you need continued treatment you can be held for a longer period of time. If you are held longer than 72 hours you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided free.

 

33(d) For each patient admitted for 72-hour evaluation and
34treatment, the facility shall keep with the patient’s medical record
35a record of the advisement given pursuant to subdivision (c) which
36shall include:

37(1) Name of person performing advisement.

38(2) Date.

39(3) Whether advisement was completed.

40(4) If not completed, a statement of good cause.

P68   1If the advisement was not completed at admission, the
2advisement process shall be continued on the ward until completed.
3A record of the matters prescribed by subdivisions (a), (b), and (c)
4shall be kept with the patient’s medical record.

5

SEC. 34.  

Section 5202 of the Welfare and Institutions Code is
6amended to read:

7

5202.  

The person or agency designated by the county shall
8prepare the petition and all other forms required in the proceeding,
9and shall be responsible for filing the petition. Before filing the
10petition, the person or agency designated by the county shall
11request the person or agency designated by the county and
12approved by the State Department of Health Care Services to
13provide prepetition screening to determine whether there is
14probable cause to believe the allegations. The person or agency
15providing prepetition screening shall conduct a reasonable
16investigation of the allegations and make a reasonable effort to
17personally interview the subject of the petition. The screening shall
18also determine whether the person will agree voluntarily to receive
19crisis intervention services or an evaluation in his own home or in
20a facility designated by the county and approved by the State
21Department of Health Care Services. Following prepetition
22screening, the person or agency designated by the county shall file
23the petition if satisfied that there is probable cause to believe that
24the person is, as a result of mental disorder, a danger to others, or
25to himself or herself, or gravely disabled, and that the person will
26not voluntarily receive evaluation or crisis intervention.

27If the petition is filed, it shall be accompanied by a report
28containing the findings of the person or agency designated by the
29county to provide prepetition screening. The prepetition screening
30report submitted to the superior court shall be confidential and
31shall be subject to the provisions of Section 5328.

32

SEC. 35.  

Section 5326.9 of the Welfare and Institutions Code
33 is amended to read:

34

5326.9.  

(a) Any alleged or suspected violation of the rights
35described in Chapter 2 (commencing with Section 5150) shall be
36investigated by the local director of mental health, or his or her
37designee. Violations of Sections 5326.2 to 5326.8, inclusive,
38concerning patients involuntarily detained for evaluation or
39treatment under this part, or as a voluntary patient for psychiatric
40evaluation or treatment to a health facility, as defined in Section
P69   11250 of the Health and Safety Code, in which psychiatric
2evaluation or treatment is offered, shall also be investigated by the
3Director of Health Care Services, or his or her designee. Violations
4of Sections 5326.2 to 5326.8, inclusive, concerning persons
5committed to a state hospital shall also be investigated by the
6Director of State Hospitals, or his or her designee. If it is
7determined by the local director of mental health, the Director of
8Health Care Services, or the Director of State Hospitals that a right
9has been violated, a formal notice of violation shall be issued.

10(b) Either the local director of mental health or the Director of
11Health Care Services, upon issuing a notice of violation, may take
12any or all of the following action:

13(1) Assign a specified time period during which the violation
14shall be corrected.

15(2) Referral to the Medical Board of California or other
16professional licensing agency. Such board shall investigate further,
17if warranted, and shall subject the individual practitioner to any
18penalty the board finds necessary and is authorized to impose.

19(3) Revoke a facility’s designation and authorization under
20Section 5404 to evaluate and treat persons detained involuntarily.

21(4) Refer any violation of law to a local district attorney or the
22Attorney General for prosecution in any court with jurisdiction.

23(c) The Director of State Hospitals, upon issuing a notice of
24violation, may take any or all of the following actions:

25(1) Assign a specified time period during which the violation
26shall be corrected.

27(2) Make a referral to the Medical Board of California or other
28professional licensing agency. The board or agency shall
29investigate further, if warranted, and shall subject the individual
30practitioner to any penalty the board finds necessary and is
31authorized to impose.

32(3) Refer any violation of law to a local district attorney or the
33Attorney General for prosecution in any court with jurisdiction.

34(d) Any physician who intentionally violates Sections 5326.2
35to 5326.8, inclusive, shall be subject to a civil penalty of not more
36than five thousand dollars ($5,000) for each violation. The penalty
37may be assessed and collected in a civil action brought by the
38Attorney General in a superior court. Such intentional violation
39shall be grounds for revocation of license.

P70   1(e) Any person or facility found to have knowingly violated the
2provisions of the first paragraph of Section 5325.1 or to have
3denied without good cause any of the rights specified in Section
45325 shall pay a civil penalty, as determined by the court, of fifty
5dollars ($50) per day during the time in which the violation is not
6 corrected, commencing on the day on which a notice of violation
7was issued, not to exceed one thousand dollars ($1,000), for each
8and every violation, except that any liability under this provision
9shall be offset by an amount equal to a fine or penalty imposed for
10the same violation under the provisions of Sections 1423 to 1425,
11inclusive, or 1428 of the Health and Safety Code. These penalties
12shall be deposited in the general fund of the county in which the
13violation occurred. The local district attorney or the Attorney
14General shall enforce this section in any court with jurisdiction.
15Where the State Department of Public Health, under the provisions
16of Sections 1423 to 1425, inclusive, of the Health and Safety Code,
17determines that no violation has occurred, the provisions of
18paragraph (4) of subdivision (b) shall not apply.

19(f) The remedies provided by this subdivision shall be in addition
20to and not in substitution for any other remedies which an
21individual may have under law.

22

SEC. 36.  

Section 5358 of the Welfare and Institutions Code is
23amended to read:

24

5358.  

(a) (1) When ordered by the court after the hearing
25required by this section, a conservator appointed pursuant to this
26chapter shall place his or her conservatee as follows:

27(A) For a conservatee who is gravely disabled, as defined in
28subparagraph (A) of paragraph (1) of subdivision (h) of Section
295008, in the least restrictive alternative placement, as designated
30by the court.

31(B) For a conservatee who is gravely disabled, as defined in
32subparagraph (B) of paragraph (1) of subdivision (h) of Section
335008, in a placement that achieves the purposes of treatment of
34the conservatee and protection of the public.

35(2) The placement may include a medical, psychiatric, nursing,
36or other state-licensed facility, or a state hospital, county hospital,
37hospital operated by the Regents of the University of California,
38a United States government hospital, or other nonmedical facility
39approved by the State Department of Health Care Services or an
40agency accredited by the State Department of Health Care Services,
P71   1or in addition to any of the foregoing, in cases of chronic
2alcoholism, to a county alcoholic treatment center.

3(b) A conservator shall also have the right, if specified in the
4court order, to require his or her conservatee to receive treatment
5related specifically to remedying or preventing the recurrence of
6the conservatee’s being gravely disabled, or to require his or her
7conservatee to receive routine medical treatment unrelated to
8remedying or preventing the recurrence of the conservatee’s being
9gravely disabled. Except in emergency cases in which the
10conservatee faces loss of life or serious bodily injury, no surgery
11shall be performed upon the conservatee without the conservatee’s
12prior consent or a court order obtained pursuant to Section 5358.2
13specifically authorizing that surgery.

14(c) (1) For a conservatee who is gravely disabled, as defined
15in subparagraph (A) of paragraph (1) of subdivision (h) of Section
165008, if the conservatee is not to be placed in his or her own home
17or the home of a relative, first priority shall be to placement in a
18suitable facility as close as possible to his or her home or the home
19of a relative. For the purposes of this section, suitable facility
20means the least restrictive residential placement available and
21necessary to achieve the purpose of treatment. At the time that the
22court considers the report of the officer providing conservatorship
23investigation specified in Section 5356, the court shall consider
24available placement alternatives. After considering all the evidence
25the court shall determine the least restrictive and most appropriate
26alternative placement for the conservatee. The court shall also
27determine those persons to be notified of a change of placement.
28The fact that a person for whom conservatorship is recommended
29is not an inpatient shall not be construed by the court as an
30indication that the person does not meet the criteria of grave
31disability.

32(2) For a conservatee who is gravely disabled, as defined in
33subparagraph (B) of paragraph (1) of subdivision (h) of Section
345008, first priority shall be placement in a facility that achieves
35the purposes of treatment of the conservatee and protection of the
36public. The court shall determine the most appropriate placement
37 for the conservatee. The court shall also determine those persons
38to be notified of a change of placement, and additionally require
39the conservator to notify the district attorney or attorney
P72   1representing the originating county prior to any change of
2placement.

3(3) For any conservatee, if requested, the local mental health
4director shall assist the conservator or the court in selecting a
5placement facility for the conservatee. When a conservatee who
6is receiving services from the local mental health program is
7placed, the conservator shall inform the local mental health director
8of the facility’s location and any movement of the conservatee to
9another facility.

10(d) (1) Except for a conservatee who is gravely disabled, as
11defined in subparagraph (B) of paragraph (1) of subdivision (h)
12of Section 5008, the conservator may transfer his or her conservatee
13to a less restrictive alternative placement without a further hearing
14and court approval. In any case in which a conservator has
15reasonable cause to believe that his or her conservatee is in need
16of immediate more restrictive placement because the condition of
17the conservatee has so changed that the conservatee poses an
18immediate and substantial danger to himself or herself or others,
19the conservator shall have the right to place his or her conservatee
20in a more restrictive facility or hospital. Notwithstanding Section
215328, if the change of placement is to a placement more restrictive
22than the court-determined placement, the conservator shall provide
23written notice of the change of placement and the reason therefor
24to the court, the conservatee’s attorney, the county patient’s rights
25advocate and any other persons designated by the court pursuant
26to subdivision (c).

27(2) For a conservatee who is gravely disabled, as defined in
28subparagraph (B) of paragraph (1) of subdivision (h) of Section
295008, the conservator may not transfer his or her conservatee
30without providing written notice of the proposed change of
31placement and the reason therefor to the court, the conservatee’s
32attorney, the county patient’s rights advocate, the district attorney
33of the county that made the commitment, and any other persons
34designated by the court to receive notice. If any person designated
35to receive notice objects to the proposed transfer within 10 days
36after receiving notice, the matter shall be set for a further hearing
37and court approval. The notification and hearing is not required
38for the transfer of persons between state hospitals.

39(3) At a hearing where the conservator is seeking placement to
40a less restrictive alternative placement pursuant to paragraph (2),
P73   1the placement shall not be approved where it is determined by a
2preponderance of the evidence that the placement poses a threat
3to the safety of the public, the conservatee, or any other individual.

4(4) A hearing as to placement to a less restrictive alternative
5placement, whether requested pursuant to paragraph (2) or pursuant
6to Section 5358.3, shall be granted no more frequently than is
7provided for in Section 5358.3.

8

SEC. 37.  

Section 5366.1 of the Welfare and Institutions Code
9 is amended to read:

10

5366.1.  

(a) Any person detained as of June 30, 1969, under
11court commitment, in a private institution, a county psychiatric
12hospital, facility of the Veterans Administration, or other agency
13of the United States government, community mental health service,
14or detained in a state hospital or facility of the Veterans
15Administration upon application of a local health officer, pursuant
16to former Section 5567 or Sections 6000 to 6019, inclusive, as
17they read immediately preceding July 1, 1969, may be detained,
18after January 1, 1972, for a period no longer than 180 days, except
19as provided in this section.

20(b) Any person detained pursuant to this section on the effective
21date of this section shall be evaluated by the facility designated
22by the county and approved by the State Department of Health
23Care Services pursuant to Section 5150 as a facility for 72-hour
24treatment and evaluation. The evaluation shall be made at the
25request of the person in charge of the institution in which the person
26is detained. If in the opinion of the professional person in charge
27of the evaluation and treatment facility or his or her designee, the
28evaluation of the person can be made by the professional person
29or his or her designee at the institution in which the person is
30detained, the person shall not be required to be evaluated at the
31evaluation and treatment facility, but shall be evaluated at the
32institution where he or she is detained, or other place to determine
33if the person is a danger to others, himself or herself, or gravely
34disabled as a result of mental disorder.

35(c) Any person evaluated under this section shall be released
36from the institution in which he or she is detained immediately
37upon completion of the evaluation if in the opinion of the
38professional person in charge of the evaluation and treatment
39facility, or his or her designee, the person evaluated is not a danger
40to others, or to himself or herself, or gravely disabled as a result
P74   1of mental disorder, unless the person agrees voluntarily to remain
2in the institution in which he or she has been detained.

3(d) If in the opinion of the professional person in charge of the
4facility or his or her designee, the person evaluated requires
5intensive treatment or recommendation for conservatorship, the
6professional person or his or her designee shall proceed under
7Article 4 (commencing with Section 5250) of Chapter 2, or under
8Chapter 3 (commencing with Section 5350), of Part 1 of Division
95.

10(e) If it is determined from the evaluation that the person is
11gravely disabled and a recommendation for conservatorship is
12made, and if the petition for conservatorship for the person is not
13filed by June 30, 1972, the court commitment or detention under
14a local health officer application for the person shall terminate and
15the patient shall be released unless he or she agrees to accept
16treatment on a voluntary basis.

17

SEC. 38.  

Section 5404 of the Welfare and Institutions Code is
18amended to read:

19

5404.  

(a) Each county may designate facilities, which are not
20hospitals or clinics, as 72-hour evaluation and treatment facilities
21and as 14-day intensive treatment facilities if the facilities meet
22those requirements as the Director of Health Care Services may
23establish by regulation. The Director of Health Care Services shall
24encourage the use by counties of appropriate facilities, which are
25not hospitals or clinics, for the evaluation and treatment of patients
26pursuant to this part.

27(b) All regulations relating to the approval of facilities
28designated by the county for 72-hour treatment and evaluation and
2914-day intensive treatment facilities, heretofore adopted by the
30State Department of Mental Health, or a successor, shall remain
31in effect and shall be fully enforceable by the State Department of
32Health Care Services with respect to any facility or program
33required to be approved as a facility for 72-hour treatment and
34evaluation and 14-day intensive treatment facilities, unless and
35until readopted, amended, or repealed by the Director of Health
36Care Services. The State Department of Health Care Services shall
37succeed to and be vested with all duties, powers, purposes,
38functions, responsibilities, and jurisdiction of the State Department
39of Mental Health, or a successor, as they relate to approval of
P75   1facilities for 72-hour treatment and evaluation and 14-day intensive
2treatment facilities.

3

SEC. 39.  

Section 5405 of the Welfare and Institutions Code is
4amended to read:

5

5405.  

(a) This section shall apply to each facility licensed by
6the State Department of Health Care Services, or its delegated
7agent, on or after January 1, 2003. For purposes of this section,
8“facility” means psychiatric health facilities, as defined in Section
91250.2 of the Health and Safety Code, licensed pursuant to Chapter
109 (commencing with Section 77001) of Division 5 of Title 22 of
11the California Code of Regulations and mental health rehabilitation
12centers licensed pursuant to Chapter 3.5 (commencing with Section
13781.00) of Division 1 of Title 9 of the California Code of
14Regulations.

15(b) (1) (A) Prior to the initial licensure or first renewal of a
16license on or after January 1, 2003, of any person to operate or
17manage a facility specified in subdivision (a), the applicant or
18licensee shall submit fingerprint images and related information
19pertaining to the applicant or licensee to the Department of Justice
20for purposes of a criminal record check, as specified in paragraph
21(2), at the expense of the applicant or licensee. The Department
22of Justice shall provide the results of the criminal record check to
23the State Department of Health Care Services. The State
24Department of Health Care Services may take into consideration
25information obtained from or provided by other government
26agencies. The State Department of Health Care Services shall
27determine whether the applicant or licensee has ever been convicted
28of a crime specified in subdivision (c). The applicant or licensee
29shall submit fingerprint images and related information each time
30the position of administrator, manager, program director, or fiscal
31officer of a facility is filled and prior to actual employment for
32initial licensure or an individual who is initially hired on or after
33January 1, 2003. For purposes of this subdivision, “applicant” and
34“licensee” include the administrator, manager, program director,
35or fiscal officer of a facility.

36(B) Commencing July 1, 2013, upon the employment of, or
37contract with or for, any direct care staff, the direct care staff person
38or licensee shall submit fingerprint images and related information
39pertaining to the direct care staff person to the Department of
40Justice for purposes of a criminal record check, as specified in
P76   1paragraph (2), at the expense of the direct care staff person or
2licensee. The Department of Justice shall provide the results of
3the criminal record check to the State Department of Health Care
4Services. The State Department of Health Care Services shall
5determine whether the direct care staff person has ever been
6convicted of a crime specified in subdivision (c). The State
7Department of Health Care Services shall notify the licensee of
8these results. No direct client contact by the trainee or newly hired
9staff, or by any direct care contractor shall occur prior to clearance
10by the State Department of Health Care Services unless the trainee,
11 newly hired employee, contractor, or employee of the contractor
12is constantly supervised.

13(C) Commencing July 1, 2013, any contract for services
14provided directly to patients or residents shall contain provisions
15to ensure that the direct services contractor submits to the
16Department of Justice fingerprint images and related information
17pertaining to the direct services contractor for submission to the
18State Department of Health Care Services for purposes of a
19criminal record check, as specified in paragraph (2), at the expense
20of the direct services contractor or licensee. The Department of
21Justice shall provide the results of the criminal record check to the
22State Department of Health Care Services. The State Department
23of Health Care Services shall determine whether the direct services
24contractor has ever been convicted of a crime specified in
25subdivision (c). The State Department of Health Care Services
26shall notify the licensee of these results.

27(2) If the applicant, licensee, direct care staff person, or direct
28services contractor specified in paragraph (1) has resided in
29California for at least the previous seven years, the applicant,
30licensee, direct care staff person, or direct services contractor shall
31only submit one set of fingerprint images and related information
32to the Department of Justice. The Department of Justice shall
33charge a fee sufficient to cover the reasonable cost of processing
34the fingerprint submission. Fingerprints and related information
35submitted pursuant to this subdivision include fingerprint images
36captured and transmitted electronically. When requested, the
37Department of Justice shall forward one set of fingerprint images
38to the Federal Bureau of Investigation for the purpose of obtaining
39any record of previous convictions or arrests pending adjudication
40of the applicant, licensee, direct care staff person, or direct services
P77   1contractor. The results of a criminal record check provided by the
2Department of Justice shall contain every conviction rendered
3against an applicant, licensee, direct care staff person, or direct
4services contractor, and every offense for which the applicant,
5licensee, direct care staff person, or direct services contractor is
6presently awaiting trial, whether the person is incarcerated or has
7been released on bail or on his or her own recognizance pending
8trial. The State Department of the Health Care Services shall
9request subsequent arrest notification from the Department of
10Justice pursuant to Section 11105.2 of the Penal Code.

11(3) An applicant and any other person specified in this
12subdivision, as part of the background clearance process, shall
13provide information as to whether or not the person has any prior
14criminal convictions, has had any arrests within the past 12-month
15period, or has any active arrests, and shall certify that, to the best
16of his or her knowledge, the information provided is true. This
17requirement is not intended to duplicate existing requirements for
18individuals who are required to submit fingerprint images as part
19of a criminal background clearance process. Every applicant shall
20provide information on any prior administrative action taken
21against him or her by any federal, state, or local government agency
22and shall certify that, to the best of his or her knowledge, the
23information provided is true. An applicant or other person required
24to provide information pursuant to this section that knowingly or
25willfully makes false statements, representations, or omissions
26may be subject to administrative action, including, but not limited
27to, denial of his or her application or exemption or revocation of
28any exemption previously granted.

29(c) (1) The State Department of Health Care Services shall
30deny any application for any license, suspend or revoke any
31existing license, and disapprove or revoke any employment or
32contract for direct services, if the applicant, licensee, employee,
33or direct services contractor has been convicted of, or incarcerated
34for, a felony defined in subdivision (c) of Section 667.5 of, or
35subdivision (c) of Section 1192.7 of, the Penal Code, within the
36preceding 10 years.

37(2) The application for licensure or renewal of any license shall
38be denied, and any employment or contract to provide direct
39services shall be disapproved or revoked, if the criminal record of
40the person includes a conviction in another jurisdiction for an
P78   1offense that, if committed or attempted in this state, would have
2been punishable as one or more of the offenses referred to in
3paragraph (1).

4(d) (1) The State Department of Health Care Services may
5approve an application for, or renewal of, a license, or continue
6any employment or contract for direct services, if the person has
7been convicted of a misdemeanor offense that is not a crime upon
8the person of another, the nature of which has no bearing upon the
9duties for which the person will perform as a licensee, direct care
10staff person, or direct services contractor. In determining whether
11to approve the application, employment, or contract for direct
12services, the department shall take into consideration the factors
13enumerated in paragraph (2).

14(2) Notwithstanding subdivision (c), if the criminal record of a
15person indicates any conviction other than a minor traffic violation,
16the State Department of Health Care Services may deny the
17application for license or renewal, and may disapprove or revoke
18any employment or contract for direct services. In determining
19whether or not to deny the application for licensure or renewal, or
20to disapprove or revoke any employment or contract for direct
21services, the department shall take into consideration the following
22factors:

23(A) The nature and seriousness of the offense under
24consideration and its relationship to the person’s employment,
25duties, and responsibilities.

26(B) Activities since conviction, including employment or
27participation in therapy or education, that would indicate changed
28behavior.

29(C) The time that has elapsed since the commission of the
30conduct or offense and the number of offenses.

31(D) The extent to which the person has complied with any terms
32of parole, probation, restitution, or any other sanction lawfully
33imposed against the person.

34(E) Any rehabilitation evidence, including character references,
35submitted by the person.

36(F) Employment history and current employer recommendations.

37(G) Circumstances surrounding the commission of the offense
38that would demonstrate the unlikelihood of repetition.

39(H) The granting by the Governor of a full and unconditional
40pardon.

P79   1(I) A certificate of rehabilitation from a superior court.

2(e) Denial, suspension, or revocation of a license, or disapproval
3or revocation of any employment or contract for direct services
4specified in subdivision (c) and paragraph (2) of subdivision (d)
5are not subject to appeal, except as provided in subdivision (f).

6(f) After a review of the record, the director may grant an
7exemption from denial, suspension, or revocation of any license,
8or disapproval of any employment or contract for direct services,
9if the crime for which the person was convicted was a property
10crime that did not involve injury to any person and the director
11has substantial and convincing evidence to support a reasonable
12belief that the person is of such good character as to justify issuance
13or renewal of the license or approval of the employment or contract.

14(g) A plea or verdict of guilty, or a conviction following a plea
15of nolo contendere shall be deemed a conviction within the
16meaning of this section. The State Department of Health Care
17Services may deny any application, or deny, suspend, or revoke a
18license, or disapprove or revoke any employment or contract for
19direct services based on a conviction specified in subdivision (c)
20when the judgment of conviction is entered or when an order
21granting probation is made suspending the imposition of sentence.

22(h) (1) For purposes of this section, “direct care staff” means
23any person who is an employee, contractor, or volunteer who has
24contact with other patients or residents in the provision of services.
25Administrative and licensed personnel shall be considered direct
26care staff when directly providing program services to participants.

27(2) An additional background check shall not be required
28pursuant to this section if the direct care staff or licensee has
29received a prior criminal history background check while working
30in a mental health rehabilitation center or psychiatric health facility
31licensed by the State Department of Health Care Services, and
32provided the department has maintained continuous subsequent
33arrest notification on the individual from the Department of Justice
34since the prior criminal background check was initiated.

35(3) When an application is denied on the basis of a conviction
36pursuant to this section, the State Department of Health Care
37Services shall provide the individual whose application was denied
38with notice, in writing, of the specific grounds for the proposed
39denial.

P80   1

SEC. 40.  

Section 5585.21 of the Welfare and Institutions Code
2 is amended to read:

3

5585.21.  

The Director of Health Care Services may promulgate
4regulations as necessary to implement and clarify the provisions
5of this part as they relate to minors.

6

SEC. 41.  

Section 5585.50 of the Welfare and Institutions Code
7 is amended to read:

8

5585.50.  

(a) When any minor, as a result of mental disorder,
9is a danger to others, or to himself or herself, or gravely disabled
10and authorization for voluntary treatment is not available, a peace
11officer, member of the attending staff, as defined by regulation,
12of an evaluation facility designated by the county, or other
13professional person designated by the county may, upon probable
14cause, take, or cause to be taken, the minor into custody and place
15him or her in a facility designated by the county and approved by
16the State Department of Health Care Services as a facility for
1772-hour treatment and evaluation of minors. The facility shall
18make every effort to notify the minor’s parent or legal guardian
19as soon as possible after the minor is detained.

20(b) The facility shall require an application in writing stating
21the circumstances under which the minor’s condition was called
22to the attention of the officer, member of the attending staff, or
23professional person, and stating that the officer, member of the
24attending staff, or professional person has probable cause to believe
25that the minor is, as a result of mental disorder, a danger to others,
26or to himself or herself, or gravely disabled and authorization for
27voluntary treatment is not available. If the probable cause is based
28on the statement of a person other than the officer, member of the
29attending staff, or professional person, the person shall be liable
30in a civil action for intentionally giving a statement which he or
31she knows to be false.

32

SEC. 42.  

Section 5585.55 of the Welfare and Institutions Code
33 is amended to read:

34

5585.55.  

The minor committed for involuntary treatment under
35this part shall be placed in a mental health facility designated by
36the county and approved by the State Department of Health Care
37Services as a facility for 72-hour evaluation and treatment. Except
38as provided for in Section 5751.7, each county shall ensure that
39minors under 16 years of age are not held with adults receiving
40psychiatric treatment under the provisions of the
P81   1Lanterman-Petris-Short Act (Part 1 (commencing with Section
25000)).

3

SEC. 43.  

Section 5675 of the Welfare and Institutions Code is
4amended to read:

5

5675.  

(a) Mental health rehabilitation centers shall only be
6licensed by the State Department of Health Care Services
7subsequent to application by counties, county contract providers,
8or other organizations. In the application for a mental health
9rehabilitation center, program evaluation measures shall include,
10but not be limited to:

11(1) That the clients placed in the facilities show improved global
12assessment scores, as measured by preadmission and postadmission
13tests.

14(2) That the clients placed in the facilities demonstrate improved
15functional behavior as measured by preadmission and
16postadmission tests.

17(3) That the clients placed in the facilities have reduced
18medication levels as determined by comparison of preadmission
19and postadmission records.

20(b) The State Department of Health Care Services shall conduct
21annual licensing inspections of mental health rehabilitation centers.

22(c) All regulations relating to the licensing of mental health
23rehabilitation centers, heretofore adopted by the State Department
24of Mental Health, or its successor, shall remain in effect and shall
25be fully enforceable by the State Department of Health Care
26Services with respect to any facility or program required to be
27licensed as a mental health rehabilitation center, unless and until
28readopted, amended, or repealed by the Director of Health Care
29Services. The State Department of Health Care Services shall
30succeed to and be vested with all duties, powers, purposes,
31functions, responsibilities, and jurisdiction of the State Department
32of Mental Health, and its successor, if any, as they relate to
33licensing mental health rehabilitation centers.

34

SEC. 44.  

Section 5675.1 of the Welfare and Institutions Code
35 is amended to read:

36

5675.1.  

(a) In accordance with subdivision (b), the State
37Department of Health Care Services may establish a system for
38the imposition of prompt and effective civil sanctions for long-term
39care facilities licensed or certified by the department, including
40facilities licensed under the provisions of Sections 5675 and 5768,
P82   1and including facilities certified as providing a special treatment
2program under Sections 72443 to 72475, inclusive, of Title 22 of
3the California Code of Regulations.

4(b) If the department determines that there is or has been a
5failure, in a substantial manner, on the part of any such facility to
6comply with the applicable laws and regulations, the director may
7 impose the following sanctions:

8(1) A plan of corrective action that addresses all failure identified
9by the department and includes timelines for correction.

10(2) A facility that is issued a plan of corrective action, and that
11fails to comply with the plan and repeats the deficiency, may be
12subject to immediate suspension of its license or certification, until
13the deficiency is corrected, when failure to comply with the plan
14of correction may cause a health or safety risk to residents.

15(c) The department may also establish procedures for the appeal
16of an administrative action taken pursuant to this section, including
17a plan of corrective action or a suspension of license or
18 certification.

19

SEC. 45.  

Section 5675.2 of the Welfare and Institutions Code
20 is amended to read:

21

5675.2.  

(a) There is hereby created in the State Treasury the
22Mental Health Facility Licensing Fund, from which money, upon
23appropriation by the Legislature in the Budget Act, shall be
24expended by the State Department of Health Care Services to fund
25administrative and other activities in support of the mental health
26licensing and certification functions of the State Department of
27Health Care Services. The Mental Health Facility Licensing Fund
28is the successor to the Licensing and Certification Fund, Mental
29Health, which fund is hereby abolished. All references in any law
30to the Licensing and Certification Fund, Mental Health shall be
31deemed to refer to the Mental Health Facility Licensing Fund.

32(b) Commencing January 1, 2005, each new and renewal
33application for a license to operate a mental health rehabilitation
34center shall be accompanied by an application or renewal fee.

35(c) The amount of the fees shall be determined and collected
36by the State Department of Health Care Services, but the total
37amount of the fees collected shall not exceed the actual costs of
38licensure and regulation of the centers, including, but not limited
39 to, the costs of processing the application, inspection costs, and
40other related costs.

P83   1(d) Each license or renewal issued pursuant to this chapter shall
2expire 12 months from the date of issuance. Application for
3renewal of the license shall be accompanied by the necessary fee
4and shall be filed with the department at least 30 days prior to the
5expiration date. Failure to file a timely renewal may result in
6expiration of the license.

7(e) License and renewal fees collected pursuant to this section
8shall be deposited into the Mental Health Facility Licensing Fund.

9(f) Fees collected by the State Department of Health Care
10Services pursuant to this section shall be expended by the State
11Department of Health Care Services for the purpose of ensuring
12the health and safety of all individuals providing care and
13supervision by licensees and to support activities of the department,
14including, but not limited to, monitoring facilities for compliance
15with applicable laws and regulations.

16(g) The State Department of Health Care Services may make
17additional charges to the facilities if additional visits are required
18to ensure that corrective action is taken by the licensee.

19

SEC. 46.  

Section 5751.7 of the Welfare and Institutions Code
20 is amended to read:

21

5751.7.  

(a) For the purposes of this part and the
22Lanterman-Petris-Short Act (Part 1 (commencing with Section
235000)), the State Department of Health Care Services and the State
24Department of State Hospitals shall ensure that, whenever feasible,
25minors shall not be admitted into psychiatric treatment with adults
26if the health facility has no specific separate housing arrangements,
27treatment staff, and treatment programs designed to serve children
28or adolescents. The Director of Health Care Services shall provide
29waivers to counties, upon their request, if this policy creates undue
30hardship in any county due to inadequate or unavailable alternative
31resources. In granting the waivers, the Director of Health Care
32Services shall require the county to establish specific treatment
33protocols and administrative procedures for identifying and
34providing appropriate treatment to minors admitted with adults.

35(b) However, notwithstanding any other provision of law, no
36minor may be admitted for psychiatric treatment into the same
37treatment ward as any adult receiving treatment who is in the
38custody of any jailor for a violent crime, is a known registered sex
39offender, or has a known history of, or exhibits inappropriate,
P84   1sexual, or other violent behavior which would present a threat to
2the physical safety of minors.

3

SEC. 47.  

Section 5768 of the Welfare and Institutions Code is
4amended to read:

5

5768.  

(a) Notwithstanding any other provision of law, except
6as to requirements relating to fire and life safety of persons with
7mental illness, the State Department of Health Care Services, in
8its discretion, may permit new programs to be developed and
9implemented without complying with licensure requirements
10established pursuant to existing state law.

11(b) Any program developed and implemented pursuant to
12subdivision (a) shall be reviewed at least once each six months,
13as determined by the State Department of Health Care Services.

14(c) The State Department of Health Care Services may establish
15appropriate licensing requirements for these new programs upon
16a determination that the programs should be continued.

17(d) Within six years, any program shall require a licensure
18category if it is to be continued. However, in the event that any
19agency other than the State Department of Health Care Services
20is responsible for developing a licensure category and fails to do
21so within the six years, the program may continue to be developed
22and implemented pursuant to subdivisions (a) and (b) until such
23time that the licensure category is established.

24(e) (1) A nongovernmental entity proposing a program shall
25submit a program application and plan to the local mental health
26director that describes at least the following components: clinical
27treatment programs, activity programs, administrative policies and
28procedures, admissions, discharge planning, health records content,
29health records service, interdisciplinary treatment teams, client
30empowerment, patient rights, pharmaceutical services, program
31space requirements, psychiatric and psychological services,
32rehabilitation services, restraint and seclusion, space, supplies,
33equipment, and staffing standards. If the local mental health
34director determines that the application and plan are consistent
35with local needs and satisfactorily address the above components,
36he or she may approve the application and plan and forward them
37to the department.

38(2) Upon the State Department of Health Care Services’
39approval, the local mental health director shall implement the
40program and shall be responsible for regular program oversight
P85   1and monitoring. The department shall be notified in writing of the
2outcome of each review of the program by the local mental health
3director, or his or her designee, for compliance with program
4requirements. The department shall retain ultimate responsibility
5for approving the method for review of each program, and the
6authority for determining the appropriateness of the local program’s
7oversight and monitoring activities.

8(f) Governmental entities proposing a program shall submit a
9program application and plan to the State Department of Health
10Care Services that describes at least the components described in
11subdivision (e). Upon approval, the department shall be responsible
12for program oversight and monitoring.

13(g) Implementation of a program shall be contingent upon the
14State Department of Health Care Services’ approval, and the
15department may reject applications or require modifications as it
16deems necessary. The department shall respond to each proposal
17within 90 days of receipt.

18(h) The State Department of Health Care Services shall submit
19an evaluation to the Legislature of all pilot projects authorized
20pursuant to this section within five years of the commencement
21of operation of the pilot project, determining the effectiveness of
22that program or facility, or both, based on, but not limited to,
23changes in clinical indicators with respect to client functions.

24

SEC. 48.  

Section 5840 of the Welfare and Institutions Code is
25amended to read:

26

5840.  

(a) The State Department of Health Care Services, in
27coordination with counties, shall establish a program designed to
28prevent mental illnesses from becoming severe and disabling. The
29program shall emphasize improving timely access to services for
30underserved populations.

31(b) The program shall include the following components:

32(1) Outreach to families, employers, primary care health care
33providers, and others to recognize the early signs of potentially
34severe and disabling mental illnesses.

35(2) Access and linkage to medically necessary care provided
36by county mental health programs for children with severe mental
37illness, as defined in Section 5600.3, and for adults and seniors
38with severe mental illness, as defined in Section 5600.3, as early
39in the onset of these conditions as practicable.

P86   1(3) Reduction in stigma associated with either being diagnosed
2with a mental illness or seeking mental health services.

3(4) Reduction in discrimination against people with mental
4illness.

5(c) The program shall include mental health services similar to
6those provided under other programs effective in preventing mental
7illnesses from becoming severe, and shall also include components
8similar to programs that have been successful in reducing the
9duration of untreated severe mental illnesses and assisting people
10in quickly regaining productive lives.

11(d) The program shall emphasize strategies to reduce the
12following negative outcomes that may result from untreated mental
13illness:

14(1) Suicide.

15(2) Incarcerations.

16(3) School failure or dropout.

17(4) Unemployment.

18(5) Prolonged suffering.

19(6) Homelessness.

20(7) Removal of children from their homes.

21(e) Prevention and early intervention funds may be used to
22broaden the provision of community-based mental health services
23by adding prevention and early intervention services or activities
24to these services.

25(f) In consultation with mental health stakeholders, and
26consistent with regulations from the Mental Health Services
27Oversight and Accountability Commission, pursuant to Section
285846, the department shall revise the program elements in Section
295840 applicable to all county mental health programs in future
30years to reflect what is learned about the most effective prevention
31and intervention programs for children, adults, and seniors.

32

SEC. 49.  

Section 5845 of the Welfare and Institutions Code is
33amended to read:

34

5845.  

(a) The Mental Health Services Oversight and
35Accountability Commission is hereby established to oversee Part
363 (commencing with Section 5800), the Adult and Older Adult
37Mental Health System of Care Act; Part 3.1 (commencing with
38Section 5820), Human Resources, Education, and Training
39Programs; Part 3.2 (commencing with Section 5830), Innovative
40Programs; Part 3.6 (commencing with Section 5840), Prevention
P87   1and Early Intervention Programs; and Part 4 (commencing with
2Section 5850), the Children’s Mental Health Services Act. The
3commission shall replace the advisory committee established
4pursuant to Section 5814. The commission shall consist of 16
5voting members as follows:

6(1) The Attorney General or his or her designee.

7(2) The Superintendent of Public Instruction or his or her
8designee.

9(3) The Chairperson of the Senate Health and Human Services
10Committee or another member of the Senate selected by the
11President pro Tempore of the Senate.

12(4) The Chairperson of the Assembly Health Committee or
13another member of the Assembly selected by the Speaker of the
14Assembly.

15(5) Two persons with a severe mental illness, a family member
16of an adult or senior with a severe mental illness, a family member
17of a child who has or has had a severe mental illness, a physician
18specializing in alcohol and drug treatment, a mental health
19 professional, a county sheriff, a superintendent of a school district,
20a representative of a labor organization, a representative of an
21employer with less than 500 employees and a representative of an
22employer with more than 500 employees, and a representative of
23a health care services plan or insurer, all appointed by the
24Governor. In making appointments, the Governor shall seek
25individuals who have had personal or family experience with
26mental illness.

27(b) Members shall serve without compensation, but shall be
28reimbursed for all actual and necessary expenses incurred in the
29performance of their duties.

30(c) The term of each member shall be three years, to be
31staggered so that approximately one-third of the appointments
32expire in each year.

33(d) In carrying out its duties and responsibilities, the commission
34may do all of the following:

35(1) Meet at least once each quarter at any time and location
36convenient to the public as it may deem appropriate. All meetings
37of the commission shall be open to the public.

38(2) Within the limit of funds allocated for these purposes,
39pursuant to the laws and regulations governing state civil service,
40employ staff, including any clerical, legal, and technical assistance
P88   1as may appear necessary. The commission shall administer its
2operations separate and apart from the State Department of Health
3Care Services and the California Health and Human Services
4Agency.

5(3) Establish technical advisory committees such as a committee
6of consumers and family members.

7(4) Employ all other appropriate strategies necessary or
8convenient to enable it to fully and adequately perform its duties
9and exercise the powers expressly granted, notwithstanding any
10authority expressly granted to any officer or employee of state
11government.

12(5) Enter into contracts.

13(6) Obtain data and information from the State Department of
14Health Care Services, the Office of Statewide Health Planning and
15Development, or other state or local entities that receive Mental
16Health Services Act funds, for the commission to utilize in its
17oversight, review, training and technical assistance, accountability,
18and evaluation capacity regarding projects and programs supported
19with Mental Health Services Act funds.

20(7) Participate in the joint state-county decisionmaking process,
21as contained in Section 4061, for training, technical assistance,
22and regulatory resources to meet the mission and goals of the
23state’s mental health system.

24(8) Develop strategies to overcome stigma and discrimination,
25and accomplish all other objectives of Part 3.2 (commencing with
26Section 5830), 3.6 (commencing with Section 5840), and the other
27provisions of the act establishing this commission.

28(9) At any time, advise the Governor or the Legislature regarding
29actions the state may take to improve care and services for people
30with mental illness.

31(10) If the commission identifies a critical issue related to the
32performance of a county mental health program, it may refer the
33issue to the State Department of Health Care Services pursuant to
34Section 5655.

35(11) Assist in providing technical assistance to accomplish the
36purposes of the Mental Health Services Act, Part 3 (commencing
37with Section 5800), and Part 4 (commencing with Section 5850)
38in collaboration with the State Department of Health Care Services
39and in consultation with the California Mental Health Directors
40Association.

P89   1(12) Work in collaboration with the State Department of Health
2Care Services and the California Mental Health Planning Council,
3and in consultation with the California Mental Health Directors
4Association, in designing a comprehensive joint plan for a
5coordinated evaluation of client outcomes in the community-based
6mental health system, including, but not limited to, parts listed in
7subdivision (a). The California Health and Human Services Agency
8shall lead this comprehensive joint plan effort.

9

SEC. 50.  

Section 5846 of the Welfare and Institutions Code is
10amended to read:

11

5846.  

(a) The commission shall adopt regulations for programs
12and expenditures pursuant to Part 3.2 (commencing with Section
135830), for innovative programs, and Part 3.6 (commencing with
14Section 5840), for prevention and early intervention.

15(b) Any regulations adopted by the department pursuant to
16Section 5898 shall be consistent with the commission’s regulations.

17(c) The commission may provide technical assistance to any
18county mental health plan as needed to address concerns or
19recommendations of the commission or when local programs could
20benefit from technical assistance for improvement of their plans.

21(d) The commission shall ensure that the perspective and
22participation of diverse community members reflective of
23California populations and others suffering from severe mental
24illness and their family members is a significant factor in all of its
25decisions and recommendations.

26

SEC. 51.  

Section 5909 of the Welfare and Institutions Code is
27amended to read:

28

5909.  

(a) The Director of Health Care Services shall retain the
29authority and responsibility to monitor and approve special
30treatment programs in skilled nursing facilities in accordance with
31Sections 72443 to 72475, inclusive, of Title 22 of the California
32Code of Regulations.

33(b) The State Department of Health Care Services shall conduct
34annual certification inspections of special treatment programs for
35the mentally disordered for the purpose of approving the special
36treatment programs that are located in skilled nursing facilities
37licensed pursuant to Section 1265 of the Health and Safety Code.

38

SEC. 52.  

Section 6007 of the Welfare and Institutions Code is
39amended to read:

P90   1

6007.  

(a) Any person detained pursuant to this section shall
2be evaluated by the facility designated by the county and approved
3by the State Department of Health Care Services pursuant to
4Section 5150 as a facility for 72-hour treatment and evaluation.
5The evaluation shall be made at the request of the person in charge
6of the private institution in which the person is detained or by one
7of the physicians who signed the certificate. If in the opinion of
8the professional person in charge of the evaluation and treatment
9facility or his or her designee, the evaluation of the person can be
10made by the professional person or his or her designee at the private
11institution in which the person is detained, the person shall not be
12required to be evaluated at the evaluation and treatment facility,
13but shall be evaluated at the private institution to determine if the
14person is a danger to others, himself or herself, or gravely disabled
15as a result of mental disorder.

16(b) Any person evaluated under this section shall be released
17from the private institution immediately upon completion of the
18evaluation if in the opinion of the professional person in charge
19of the evaluation and treatment facility, or his or her designee, the
20person evaluated is not a danger to others, or to himself or herself,
21or gravely disabled as a result of mental disorder, unless the person
22agrees voluntarily to remain in the private institution.

23(c) If in the opinion of the professional person in charge of the
24facility or his or her designee, the person evaluated requires
25intensive treatment or recommendation for conservatorship, the
26professional person or his or her designee shall proceed under
27Article 4 (commencing with Section 5250) of Chapter 2, or under
28Chapter 3 (commencing with Section 5350), of Part 1 of Division
295.

30

SEC. 53.  

Section 6551 of the Welfare and Institutions Code is
31amended to read:

32

6551.  

(a) If the court is in doubt as to whether the person is
33mentally disordered or intellectually disabled, the court shall order
34the person to be taken to a facility designated by the county and
35approved by the State Department of Health Care Services as a
36facility for 72-hour treatment and evaluation. Thereupon, Article
37 1 (commencing with Section 5150) of Chapter 2 of Part 1 of
38Division 5 applies, except that the professional person in charge
39of the facility shall make a written report to the court concerning
40the results of the evaluation of the person’s mental condition. If
P91   1the professional person in charge of the facility finds the person
2is, as a result of mental disorder, in need of intensive treatment,
3the person may be certified for not more than 14 days of
4involuntary intensive treatment if the conditions set forth in
5subdivision (c) of Section 5250 and subdivision (b) of Section
65260 are complied with. Thereupon, Article 4 (commencing with
7Section 5250) of Chapter 2 of Part 1 of Division 5 shall apply to
8the person. The person may be detained pursuant to Article 4.5
9(commencing with Section 5260), or Article 4.7 (commencing
10with Section 5270.10), or Article 6 (commencing with Section
115300) of Part 1 of Division 5 if that article applies.

12(b) If the professional person in charge of the facility finds that
13the person is intellectually disabled, the juvenile court may direct
14the filing in any other court of a petition for the commitment of a
15minor as an intellectually disabled person to the State Department
16of Developmental Services for placement in a state hospital. In
17such case, the juvenile court shall transmit to the court in which
18the petition is filed a copy of the report of the professional person
19in charge of the facility in which the minor was placed for
20observation. The court in which the petition for commitment is
21filed may accept the report of the professional person in lieu of
22the appointment, or subpoenaing, and testimony of other expert
23witnesses appointed by the court, if the laws applicable to such
24commitment proceedings provide for the appointment by court of
25medical or other expert witnesses or may consider the report as
26evidence in addition to the testimony of medical or other expert
27witnesses.

28(c) If the professional person in charge of the facility for 72-hour
29evaluation and treatment reports to the juvenile court that the minor
30is not affected with any mental disorder requiring intensive
31treatment or intellectual disability, the professional person in charge
32of the facility shall return the minor to the juvenile court on or
33before the expiration of the 72-hour period and the court shall
34proceed with the case in accordance with the Juvenile Court Law.

35(d) Any expenditure for the evaluation or intensive treatment
36of a minor under this section shall be considered an expenditure
37made under Part 2 (commencing with Section 5600) of Division
385 and shall be reimbursed by the state as are other local
39expenditures pursuant to that part.

P92   1(e) The jurisdiction of the juvenile court over the minor shall
2be suspended during the time that the minor is subject to the
3jurisdiction of the court in which the petition for postcertification
4treatment of an imminently dangerous person or the petition for
5commitment of an intellectually disabled person is filed or under
6remand for 90 days for intensive treatment or commitment ordered
7by the court.

8

SEC. 54.  

Section 7100 of the Welfare and Institutions Code is
9amended to read:

10

7100.  

(a) The board of supervisors of each county may
11maintain in the county hospital or in any other hospital situated
12within or without the county or in any other psychiatric health
13facility situated within or without the county, suitable facilities
14and nonhospital or hospital service for the detention, supervision,
15care, and treatment of persons who are mentally disordered or
16developmentally disabled, or who are alleged to be such.

17(b) The county may contract with public or private hospitals for
18those facilities and hospital service when they are not suitably
19available in any institution, psychiatric facility, or establishment
20maintained or operated by the county.

21(c) The facilities and services for the mentally disordered and
22allegedly mentally disordered shall be subject to the approval of
23the State Department of Health Care Services, and the facilities
24and services for the developmentally disabled and allegedly
25developmentally disabled shall be subject to the approval of the
26State Department of Developmental Services. The professional
27person having charge and control of the hospital or psychiatric
28health facility shall allow the department whose approval is
29required to make investigations thereof as it deems necessary at
30any time.

31(d) Nothing in this chapter means that mentally disordered or
32developmentally disabled persons may not be detained, supervised,
33cared for, or treated, subject to the right of inquiry or investigation
34by the department, in their own homes, or the homes of their
35relatives or friends, or in a licensed establishment.

36begin insert

begin insertSEC. 54.5.end insert  

end insert

begin insertSection 14005.275 is added to the end insertbegin insertWelfare and
37Institutions Code
end insert
begin insert, to read:end insert

begin insert
38

begin insert14005.275.end insert  

The department shall ensure coordination of
39covered services across all delivery systems of care in order to
40minimize disruption in services for children transitioning from the
P93   1Healthy Families Program to Medi-Cal pursuant to Chapter 28
2of the Statutes of 2012.

end insert
3

SEC. 55.  

Section 14005.281 is added to the Welfare and
4Institutions Code
, immediately following Section 14005.28, to
5read:

6

14005.281.  

(a) The department shall maintain eligibility for
7all former independent foster care adolescents who were receiving
8services pursuant to Section 14005.28 on or after July 1, 2013, but
9no later than December 31, 2013, and lost Medi-Cal coverage as
10a result of attaining 21 years of age.

11(b) Subdivision (a) shall be implemented using state general
12funds to the extent federal financial participation is not available.

13(c) This section shall remain in effect only until January 1, 2014,
14and as of that date is repealed, unless a later enacted statute, that
15is enacted before January 1, 2014, deletes or extends that date.

16

SEC. 56.  

Section 14100.3 is added to the Welfare and
17Institutions Code
, to read:

18

14100.3.  

(a) The State Department of Health Care Services
19shall post on its Internet Web site all submitted state plan
20amendments and all federal waiver applications and requests for
21new waivers, waiver amendments, and waiver renewals and
22extensions, within 10 business days from the date the department
23submits these documents for approval to the federal Centers for
24Medicare and Medicaid Services (CMS).

25(b) The department shall post on its Internet Web site final
26approval or denial letters and accompanying documents for all
27submitted state plan amendments and federal waiver applications
28and requests within 10 business days from the date the department
29receives notification of final approval or denial from CMS.

30(c) If the department notifies CMS of the withdrawal of a
31submitted state plan amendment or federal waiver application or
32request, as described in subdivisions (a) and (b), the department
33shall post on its Internet Web site the withdrawal notification within
3410 business days from the date the department notifies CMS of
35the withdrawal.

36(d) Unless already posted on the Internet Web site pursuant to
37subdivisions (a) to (c), inclusive, the department shall post on its
38Internet Web site all pending submitted state plan amendments
39and federal waiver applications and requests, that the department
40submitted to CMS in 2009 and every year thereafter.

P94   1

SEC. 57.  

Section 14100.51 is added to the Welfare and
2Institutions Code
, immediately following Section 14100.5, to read:

3

14100.51.  

(a) Each year, by no later than January 10 and
4concurrently with the release of the May Revision, the State
5Department of Health Care Services shall provide to the fiscal
6committees of the Legislature supplemental fiscal information for
7the Medi-Cal Specialty Mental Health Services Program. This
8supplemental fiscal information shall include service-type
9descriptions, children’s and adults’ caseload and fiscal forecast by
10service type, a detailed explanation of changes to these forecasts,
11fiscal charts containing children’s and adults’ claim costs and
12unduplicated client counts, and summary fiscal charts with
13current-year and budget-year proposals.

14(b) For purposes of making the information described in
15subdivision (a) available to the public, the department shall post
16this information on its Internet Web site.

17

SEC. 58.  

Section 14100.52 is added to the Welfare and
18Institutions Code
, immediately following Section 14100.51, to
19read:

20

14100.52.  

(a) Each year, by no later than January 10 and
21concurrently with the release of the May Revision, the State
22Department of Health Care Services shall provide to the fiscal
23committees of the Legislature supplemental fiscal information for
24the Drug Medi-Cal Program. This supplemental fiscal information
25shall include adult, minor-consent, child, and perinatal unique
26client counts and summary fiscal charts with current-year and
27budget-year proposals.

28(b) For purposes of making the information described in
29subdivision (a) available to the public, the department shall post
30this information on its Internet Web site.

31

SEC. 59.  

Section 14105.22 of the Welfare and Institutions
32Code
is amended to read:

33

14105.22.  

(a) (1) Reimbursement for clinical laboratory or
34laboratory services, as defined in Section 51137.2 of Title 22 of
35the California Code of Regulations, shall not exceed 80 percent
36of the lowest maximum allowance established by the federal
37Medicare Program for the same or similar services.

38(2) This subdivision shall be implemented only until the new
39rate methodology under subdivision (b) is approved by the federal
40Centers for Medicare and Medicaid Services (CMS).

P95   1(b) (1) It is the intent of the Legislature that the department
2develop reimbursement rates for clinical laboratory or laboratory
3services that are comparable to the payment amounts received
4from other payers for clinical laboratory or laboratory services.
5Development of these rates will enable the department to reimburse
6clinical laboratory or laboratory service providers in compliance
7with state and federal law.

8(2) (A) The provisions of Section 51501(a) of Title 22 of the
9California Code of Regulations shall not apply to laboratory
10providers reimbursed under the new rate methodology developed
11for clinical laboratories or laboratory services pursuant to this
12subdivision.

13(B) In addition to subparagraph (A), laboratory providers
14reimbursed under any payment reductions implemented pursuant
15to this section shall not be subject to the provisions of Section
1651501(a) of Title 22 of the California Code of Regulations for 21
17months following the date of implementation of this reduction.

18(3) Reimbursement to providers for clinical laboratory or
19laboratory services shall not exceed the lowest of the following:

20(A) The amount billed.

21(B) The charge to the general public.

22(C) Eighty percent of the lowest maximum allowance established
23by the federal Medicare Program for the same or similar services.

24(D) A reimbursement rate based on an average of the lowest
25amount that other payers and other state Medicaid programs are
26paying for similar clinical laboratory or laboratory services.

27(4) (A) In addition to the payment reductions implemented
28pursuant to Section 14105.192, payments shall be reduced by up
29to 10 percent for clinical laboratory or laboratory services, as
30defined in Section 51137.2 of Title 22 of the California Code of
31Regulations, for dates of service on and after July 1, 2012. The
32payment reductions pursuant to this paragraph shall continue until
33the new rate methodology under this subdivision has been approved
34by CMS.

35(B) Notwithstanding subparagraph (A), the Family Planning,
36Access, Care, and Treatment (Family PACT) Program pursuant
37to subdivision (aa) of Section 14132 shall be exempt from the
38payment reduction specified in this section.

39(5) (A) For purposes of establishing reimbursement rates for
40clinical laboratory or laboratory services based on the lowest
P96   1amounts other payers are paying providers for similar clinical
2laboratory or laboratory services, laboratory service providers shall
3submit data reports within 11 months of the date the act that added
4this paragraph becomes effective and annually thereafter. The data
5initially provided shall be for the 2011 calendar year, and for each
6subsequent year, shall be based on the previous calendar year and
7shall specify the provider’s lowest amounts other payers are paying,
8including other state Medicaid programs and private insurance,
9minus discounts and rebates. The specific data required for
10submission under this subparagraph and the format for the data
11submission shall be determined and specified by the department
12after receiving stakeholder input pursuant to paragraph (7).

13(B) The data submitted pursuant to subparagraph (A) may be
14used to determine reimbursement rates by procedure code based
15on an average of the lowest amount other payers are paying
16providers for similar clinical laboratory or laboratory services,
17excluding significant deviations of cost or volume factors and with
18consideration to geographical areas. The department shall have
19the discretion to determine the specific methodology and factors
20used in the development of the lowest average amount under this
21subparagraph to ensure compliance with federal Medicaid law and
22regulations as specified in paragraph (10).

23(C) For purposes of subparagraph (B), the department may
24contract with a vendor for the purposes of collecting payment data
25reports from clinical laboratories, analyzing payment information,
26and calculating a proposed rate.

27(D) The proposed rates calculated by the vendor described in
28subparagraph (C) may be used in determining the lowest
29reimbursement rate for clinical laboratories or laboratory services
30in accordance with paragraph (3).

31(E) Data reports submitted to the department shall be certified
32by the provider’s certified financial officer or an authorized
33individual.

34(F) Clinical laboratory providers that fail to submit data reports
35within 30 working days from the time requested by the department
36shall be subject to the suspension provisions of subdivisions (a)
37and (c) of Section 14123.

38(6) Data reports provided to the department pursuant to this
39section shall be confidential and shall be exempt from disclosure
40under the California Public Records Act (Chapter 3.5 (commencing
P97   1with Section 6250) of Division 7 of Title 1 of the Government
2Code).

3(7) The department shall seek stakeholder input on the
4ratesetting methodology.

5(8) (A) Notwithstanding Chapter 3.5 (commencing with Section
611340) of Part 1 of Division 3 of Title 2 of the Government Code,
7the department shall, without taking any further regulatory action,
8implement, interpret, or make specific this section by means of
9provider bulletins or similar instructions until regulations are
10adopted. It is the intent of the Legislature that the department have
11temporary authority as necessary to implement program changes
12until completion of the regulatory process.

13(B) The department shall adopt emergency regulations no later
14than July 1, 2014. The department may readopt any emergency
15regulation authorized by this section that is the same as or
16substantially equivalent to an emergency regulation previously
17adopted pursuant to this section. The initial adoption of emergency
18regulations implementing the amendments to this section and the
19one readoption of emergency regulations authorized by this section
20shall be deemed an emergency and necessary for the immediate
21preservation of the public peace, health, safety, or general welfare.
22Initial emergency regulations and the one readoption of emergency
23regulations authorized by this section shall be exempt from review
24by the Office of Administrative Law.

25(C) The initial emergency regulations and the one readoption
26of emergency regulations authorized by this section shall be
27submitted to the Office of Administrative Law for filing with the
28Secretary of State and each shall remain in effect for no more than
29180 days, by which time final regulations may be adopted.

30(9) To the extent that the director determines that the new
31methodology or payment reductions are not consistent with the
32requirements of Section 1396a(a)(30)(A) of Title 42 of the United
33States Code, the department may revert to the methodology under
34subdivision (a) to ensure access to care is not compromised.

35(10) (A) The department shall implement this section in a
36manner that is consistent with federal Medicaid law and
37regulations. The director shall seek any necessary federal approvals
38for the implementation of this section. This section shall be
39implemented only to the extent that federal approval is obtained.

P98   1(B) In determining whether federal financial participation is
2available, the director shall determine whether the rates and
3payments comply with applicable federal Medicaid requirements,
4including those set forth in Section 1396a(a)(30)(A) of Title 42 of
5the United States Code.

6(C) To the extent that the director determines that the rates and
7payments do not comply with applicable federal Medicaid
8requirements or that federal financial participation is not available
9with respect to any reimbursement rate, the director retains the
10discretion not to implement that rate or payment and may revise
11the rate or payment as necessary to comply with federal Medicaid
12requirements. The department shall notify the Joint Legislative
13Budget Committee 10 days prior to revising the rate or payment
14to comply with federal Medicaid requirements.

15

SEC. 60.  

Section 14105.3 of the Welfare and Institutions Code
16 is amended to read:

17

14105.3.  

(a) The department is considered to be the purchaser,
18but not the dispenser or distributor, of prescribed drugs under the
19Medi-Cal program for the purpose of enabling the department to
20obtain from manufacturers of prescribed drugs the most favorable
21price for those drugs furnished by one or more manufacturers,
22based upon the large quantity of the drugs purchased under the
23Medi-Cal program, and to enable the department, notwithstanding
24any other provision of state law, to obtain from the manufacturers
25discounts, rebates, or refunds based on the quantities purchased
26under the program, insofar as may be permissible under federal
27law. Nothing in this section shall interfere with usual and
28customary distribution practices in the drug industry.

29(b) The department may enter into exclusive or nonexclusive
30contracts on a bid or negotiated basis with manufacturers,
31distributors, dispensers, or suppliers of appliances, durable medical
32equipment, medical supplies, and other product-type health care
33services and with laboratories for clinical laboratory services for
34the purpose of obtaining the most favorable prices to the state and
35to assure adequate quality of the product or service. Except as
36provided in subdivision (f), this subdivision shall not apply to
37prescribed drugs dispensed by pharmacies licensed pursuant to
38Article 7 (commencing with Section 4110) of Chapter 9 of Division
392 of the Business and Professions Code.

P99   1(c) Notwithstanding subdivision (b), the department may not
2enter into a contract with a clinical laboratory unless the clinical
3laboratory operates in conformity with Chapter 3 (commencing
4with Section 1200) of Division 2 of the Business and Professions
5Code and the regulations adopted thereunder, and Section 263a of
6Title 42 of the United States Code and the regulations adopted
7thereunder.

8(d) The department shall contract with manufacturers of
9single-source drugs on a negotiated basis, and with manufacturers
10of multisource drugs on a bid or negotiated basis.

11(e) In order to ensure and improve access by Medi-Cal
12beneficiaries to both hearing aid appliances and provider services,
13and to ensure that the state obtains the most favorable prices, the
14department, by June 30, 2008, shall enter into exclusive or
15nonexclusive contracts, on a bid or negotiated basis, for purchasing
16 hearing aid appliances.

17(f) In order to provide specialized care in the distribution of
18specialized drugs, as identified by the department and that include,
19but are not limited to, blood factors and immunizations, the
20department may enter into contracts with providers licensed to
21dispense dangerous drugs or devices pursuant to Chapter 9
22(commencing with Section 4000) of Division 2 of the Business
23and Professions Code, for programs that qualify for federal funding
24pursuant to the Medicaid state plan, or waivers, and the programs
25authorized by Article 5 (commencing with Section 123800) of
26Chapter 3 of Part 2 of, and Article 1 (commencing with Section
27125125) of Chapter 2 of Part 5 of, Division 106 of the Health and
28Safety Code, in accordance with this subdivision.

29(1) The department shall, for purposes of ensuring proper patient
30care, consult current standards of practice when executing a
31provider contract.

32(2) The department shall, for purposes of ensuring quality of
33care to people with unique conditions requiring specialty drugs,
34contract with a nonexclusive number of providers that meet the
35needs of the affected population, covers all geographic regions in
36California, and reflects the distribution of the specialty drug in the
37community. The department may use a single provider in the event
38the product manufacturer designates a sole-source delivery
39mechanism. The department shall consult with interested parties
P100  1and appropriate stakeholders in implementing this section with
2respect to all of the following:

3(A) Notifying stakeholder representatives of the potential
4inclusion or exclusion of drugs in the specialty pharmacy program.

5(B) Allowing for written input regarding the potential inclusion
6or exclusion of drugs into the specialty pharmacy program.

7(C) Scheduling at least one public meeting regarding the
8potential inclusion or exclusion of drugs into the specialty
9pharmacy program.

10(D) Obtaining a recommendation from the Medi-Cal Drug
11Utilization Review Advisory Committee, established pursuant to
12Section 1927 of the federal Social Security Act (42 U.S.C. Sec.
131396r-8), on the inclusion or exclusion of drugs into the specialty
14pharmacy program distribution based on clinical best practices
15related to each drug considered.

16(3) For purposes of this subdivision, the definition of “blood
17factors” has the same meaning as that term is defined in Section
1814105.86.

19(4) The department shall make every reasonable effort to ensure
20all medically necessary clotting factor therapies are available for
21the treatment of people with bleeding disorders.

22(g) The department may contract with an intermediary to
23establish provider contracts pursuant to this section for programs
24that qualify for federal funding pursuant to the Medicaid state plan,
25or waivers, and the programs authorized by Article 5 (commencing
26with Section 123800) of Chapter 3 of Part 2 of, and Article 1
27(commencing with Section 125125) of Chapter 2 of Part 5 of,
28Division 106 of the Health and Safety Code.

29(h) In carrying out contracting activity for this or any section
30associated with the Medi-Cal list of contract drugs, notwithstanding
31Section 19130 of the Government Code, the department may
32contract, either directly or through the fiscal intermediary, for
33 pharmacy consultant staff necessary to accomplish the contracting
34process or treatment authorization request reviews. The fiscal
35intermediary contract, including any contract amendment, system
36change pursuant to a change order, and project or systems
37development notice shall be exempt from Part 2 (commencing
38with Section 10100) of Division 2 of the Public Contract Code
39and any policies, procedures, or regulations authorized by these
40provisions.

P101  1(i) In order to achieve maximum cost savings, the Legislature
2hereby determines that an expedited contract process for contracts
3under this section is necessary. Therefore, contracts under this
4section shall be exempt from Chapter 2 (commencing with Section
510290) of Part 2 of Division 2 of the Public Contract Code.

6(j) For purposes of implementing the contracting provisions
7specified in this section, the department shall do all of the
8following:

9(1) Ensure adequate access for Medi-Cal patients to quality
10laboratory testing services in the geographic regions of the state
11where contracting occurs.

12(2) Consult with the statewide association of clinical laboratories
13and other appropriate stakeholders on the implementation of the
14contracting provisions specified in this section to ensure maximum
15access for Medi-Cal patients consistent with the savings targets
16projected by the 2002-03 budget conference committee for clinical
17laboratory services provided under the Medi-Cal program.

18(3) Consider which types of laboratories are appropriate for
19implementing the contracting provisions specified in this section,
20including independent laboratories, outreach laboratory programs
21of hospital-based laboratories, clinic laboratories, physician office
22laboratories, and group practice laboratories.

23

SEC. 61.  

Section 14131.07 of the Welfare and Institutions
24Code
is repealed.

25

SEC. 62.  

Section 14131.10 of the Welfare and Institutions
26Code
is amended to read:

27

14131.10.  

(a) Notwithstanding any other provision of this
28chapter, Chapter 8 (commencing with Section 14200), or Chapter
298.75 (commencing with Section 14591), in order to implement
30changes in the level of funding for health care services, specific
31optional benefits are excluded from coverage under the Medi-Cal
32program.

33(b) (1) The following optional benefits are excluded from
34coverage under the Medi-Cal program:

35(A) Adult dental services, except as specified in paragraph (2).

36(B) Acupuncture services.

37(C) Audiology services and speech therapy services.

38(D) Chiropractic services.

39(E) Optometric and optician services, including services
40provided by a fabricating optical laboratory.

P102  1(F) Podiatric services.

2(G) Psychology services.

3(H) Incontinence creams and washes.

4(2) (A) Medical and surgical services provided by a doctor of
5dental medicine or dental surgery, which, if provided by a
6physician, would be considered physician services, and which
7services may be provided by either a physician or a dentist in this
8state, are covered.

9(B) Emergency procedures are also covered in the categories
10of service specified in subparagraph (A). The director may adopt
11regulations for any of the services specified in subparagraph (A).

12(C) Effective May 1, 2014, or the effective date of any necessary
13federal approvals as required by subdivision (f), whichever is later,
14for persons 21 years of age or older, adult dental benefits, subject
15to utilization controls, are limited to all the following medically
16necessary services:

17(i) Examinations, radiographs/photographic images, prophylaxis,
18and fluoride treatments.

19(ii) Amalgam and composite restorations.

20(iii) Stainless steel, resin, and resin window crowns.

21(iv) Anterior root canal therapy.

22(v) Complete dentures, including immediate dentures.

23(vi) Complete denture adjustments, repairs, and relines.

24(D) Services specified in this paragraph shall be included as a
25covered medical benefit under the Medi-Cal program pursuant to
26Section 14132.89.

27(3) Pregnancy-related services and services for the treatment of
28other conditions that might complicate the pregnancy are not
29excluded from coverage under this section.

30(c) The optional benefit exclusions do not apply to either of the
31following:

32(1) Beneficiaries under the Early and Periodic Screening
33Diagnosis and Treatment Program.

34(2) Beneficiaries receiving long-term care in a nursing facility
35that is both:

36(A) A skilled nursing facility or intermediate care facility as
37defined in subdivisions (c) and (d) of Section 1250 of the Health
38and Safety Code.

39(B) Licensed pursuant to subdivision (k) of Section 1250 of the
40Health and Safety Code.

P103  1(d) This section shall only be implemented to the extent
2permitted by federal law.

3(e) Notwithstanding Chapter 3.5 (commencing with Section
411340) of Part 1 of Division 3 of Title 2 of the Government Code,
5the department may implement the provisions of this section by
6means of all-county letters, provider bulletins, or similar
7instructions, without taking further regulatory action.

8(f) The department shall seek approval for federal financial
9participation and coverage of services specified in subparagraph
10(C) of paragraph (2) of subdivision (b) under the Medi-Cal
11program.

12(g) This section, except as specified in subparagraph (C) of
13paragraph (2) of subdivision (b), shall be implemented on the first
14 day of the month following 90 days after the operative date of this
15section.

16

SEC. 63.  

Section 14132.86 is added to the Welfare and
17Institutions Code
, to read:

18

14132.86.  

(a) Notwithstanding subdivision (ab) of Section
1914132, effective May 1, 2014, purchase of prescribed enteral
20nutrition products is covered, subject to the Medi-Cal list of enteral
21nutrition products pursuant to Section 14105.8 and utilization
22controls pursuant to Section 14105.395.

23(b) Notwithstanding Chapter 3.5 (commencing with Section
2411340) of Part 1 of Division 3 of Title 2 of the Government Code,
25the department shall implement this section by means of a provider
26bulletin or similar instruction, without taking regulatory action.

27(c) This section shall only be implemented to the extent
28permitted by federal law.

29(d) The department shall seek approval for federal financial
30participation and coverage of the service specified in subdivision
31(a) under the Medi-Cal program.

32

SEC. 64.  

Section 14132.89 is added to the Welfare and
33Institutions Code
, to read:

34

14132.89.  

(a) Notwithstanding subdivision (h) of Section
3514132, effective May 1, 2014, or the effective date of any necessary
36federal approvals as required by subdivision (d), all of the
37following are covered benefits for persons 21 years of age or older,
38subject to utilization controls and medically necessary services:

39(1)  Examinations, radiographs/photographic images,
40prophylaxis, and fluoride treatments.

P104  1(2) Amalgam and composite restorations.

2(3) Stainless steel, resin, and resin window crowns.

3(4) Anterior root canal therapy.

4(5) Complete dentures, including immediate dentures.

5(6) Complete denture adjustments, repairs, and relines.

6(7) Emergency procedures are also covered in the above
7categories of service.

8(b) This section shall only be implemented to the extent
9permitted by federal law.

10(c) Notwithstanding Chapter 3.5 (commencing with Section
1111340) of Part 1 of Division 3 of Title 2 of the Government Code,
12the department shall implement this section by means of a provider
13bulletin or similar instruction, without taking regulatory action.

14(d) The department shall seek approval for federal financial
15participation and coverage of services specified in subdivision (a)
16under the Medi-Cal program.

17

SEC. 65.  

Section 14134 of the Welfare and Institutions Code,
18as amended by Section 84 of Chapter 23 of the Statutes of 2012,
19is amended to read:

20

14134.  

(a) Except for any prescription, refill, visit, service,
21device, or item for which the program’s payment is ten dollars
22($10) or less, in which case no copayment shall be required, a
23recipient of services under this chapter shall be required to make
24copayments not to exceed the maximum permitted under federal
25regulations or federal waivers as follows:

26(1) Copayment of five dollars ($5) shall be made for
27nonemergency services received in an emergency department or
28emergency room when the services do not result in the treatment
29of an emergency medical condition or inpatient admittance. For
30the purposes of this section, “nonemergency services” means
31services not required to, as appropriate, medically screen, examine,
32evaluate, or stabilize an emergency medical condition that
33manifests itself by acute symptoms of sufficient severity, including
34severe pain, such that the absence of immediate medical attention
35could reasonably be expected to result in any of the following:

36(A) Placing the individual’s health, or, with respect to a pregnant
37woman, the health of the woman or her unborn child, in serious
38jeopardy.

39(B) Serious impairment to bodily functions.

40(C) Serious dysfunction of any bodily organ or part.

P105  1(2) Copayment of one dollar ($1) shall be made for each drug
2prescription or refill.

3(3) Copayment of one dollar ($1) shall be made for each visit
4for services under subdivisions (a) and (h) of Section 14132.

5(4) The copayment amounts set forth in paragraphs (1), (2), and
6(3) may be collected and retained or waived by the provider.

7(5) The department shall not reduce the reimbursement otherwise
8due to providers as a result of the copayment. The copayment
9amounts shall be in addition to any reimbursement otherwise due
10the provider for services rendered under this program.

11(6) This section does not apply to emergency services, family
12planning services, or to any services received by:

13(A) Any child in AFDC-Foster Care, as defined in Section
1411400.

15(B) Any person who is an inpatient in a health facility, as defined
16in Section 1250 of the Health and Safety Code.

17(C) Any person 18 years of age or under.

18(D) Any woman receiving perinatal care.

19(7) Paragraph (2) does not apply to any person 65 years of age
20or over.

21(8) A provider of service shall not deny care or services to an
22individual solely because of that person’s inability to copay under
23this section. An individual shall, however, remain liable to the
24provider for any copayment amount owed.

25(9) This section shall not apply to any preventive services that
26are assigned a grade of A or B by the United States Preventive
27Services Task Force provided by a physician or other licensed
28practitioner of the healing arts, or any approved adult vaccines and
29their administration recommended by the Advisory Committee on
30Immunization Practices. Pursuant to Section 1905(b) of the federal
31Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
32be provided without any cost sharing by the beneficiary in order
33for the state to receive an increased federal medical assistance
34percentage for these services.

35(10) The department shall seek any federal waivers necessary
36to implement this section. The provisions for which appropriate
37federal waivers cannot be obtained shall not be implemented, but
38provisions for which waivers are either obtained or found to be
39 unnecessary shall be unaffected by the inability to obtain federal
40waivers for the other provisions.

P106  1(11) The director shall adopt any regulations necessary to
2implement this section as emergency regulations in accordance
3with Chapter 3.5 (commencing with Section 11340) of Part 1 of
4Division 3 of Title 2 of the Government Code. The adoption of
5the regulations shall be deemed to be an emergency and necessary
6for the immediate preservation of the public peace, health and
7safety, or general welfare. The director shall transmit these
8emergency regulations directly to the Secretary of State for filing
9and the regulations shall become effective immediately upon filing.
10Upon completion of the formal regulation adoption process and
11prior to the expiration of the 120 day duration period of emergency
12regulations, the director shall transmit directly to the Secretary of
13State for filing the adopted regulations, the rulemaking file, and
14the certification of compliance as required by subdivision (e) of
15Section 11346.1 of the Government Code.

16(b) This section, or subdivisions thereof, if applicable, shall
17become inoperative on the implementation date for copayments
18stated in the declaration executed by the director pursuant to
19Section 14134 as added by Section 101.5 of Chapter 3 of the
20Statutes of 2011.

21

SEC. 66.  

Section 14134 of the Welfare and Institutions Code,
22as amended by Section 85 of Chapter 23 of the Statutes of 2012,
23is amended to read:

24

14134.  

(a) The Legislature finds and declares all of the
25following:

26(1) Costs within the Medi-Cal program continue to grow due
27to the rising cost of providing health care throughout the state and
28also due to increases in enrollment, which are more pronounced
29during difficult economic times.

30(2) In order to minimize the need for drastically cutting
31enrollment standards or benefits or imposing further reductions
32on Medi-Cal providers during times of economic crisis, it is crucial
33to find areas within the program where beneficiaries can share
34responsibility for utilization of health care, whether they are
35participating in the fee-for-service or the managed care model of
36service delivery.

37(3) The establishment of cost-sharing obligations within the
38Medi-Cal program is complex and is subject to close supervision
39by the United States Department of Health and Human Services.

P107  1(4) As the single state agency for Medicaid in California, the
2State Department of Health Care Services has unique expertise
3that can inform decisions that set or adjust cost-sharing
4responsibilities for Medi-Cal beneficiaries receiving health care
5services.

6(b) Therefore, it is the intent of the Legislature for the
7department to obtain federal approval to implement cost-sharing
8for Medi-Cal beneficiaries and permit providers to require that
9individuals meet their cost-sharing obligation prior to receiving
10care or services.

11(c) A Medi-Cal beneficiary shall be required to make
12copayments as described in this section. These copayments
13represent a contribution toward the rate of payment made to
14providers of Medi-Cal services and shall be as follows:

15(1) Copayment of up to fifty dollars ($50) shall be made for
16nonemergency services received in an emergency department or
17emergency room when the services do not result in the treatment
18of an emergency condition or inpatient admittance. For the
19purposes of this section, “nonemergency services” means services
20not required to, as appropriate, medically screen, examine, evaluate,
21or stabilize an emergency medical condition that manifests itself
22by acute symptoms of sufficient severity, including severe pain,
23such that the absence of immediate medical attention could
24reasonably be expected to result in any of the following:

25(A) Placing the individual’s health, or, with respect to a pregnant
26woman, the health of the woman or her unborn child, in serious
27jeopardy.

28(B) Serious impairment to bodily functions.

29(C) Serious dysfunction of any bodily organ or part.

30(2) Copayment of up to fifty dollars ($50) shall be made for
31emergency services received in an emergency department or
32emergency room when the services result in the treatment of an
33emergency medical condition or inpatient admittance. For purposes
34of this section, “emergency services” means services required to,
35as appropriate, medically screen, examine, evaluate, or stabilize
36an emergency medical condition that manifests itself by acute
37symptoms of sufficient severity, including severe pain, such that
38the absence of immediate medical attention could reasonably be
39expected to result in any of the following:

P108  1(A) Placing the individual’s health, or, with respect to a pregnant
2woman, the health of the woman or her unborn child, in serious
3jeopardy.

4(B) Serious impairment to bodily functions.

5(C) Serious dysfunction of any bodily organ or part.

6(3) Copayment of up to one hundred dollars ($100) shall be
7made for each hospital inpatient day, up to a maximum of two
8hundred dollars ($200) per admission.

9(4) Copayment of up to three dollars ($3) shall be made for each
10preferred drug prescription or refill. A copayment of up to five
11dollars ($5) shall be made for each nonpreferred drug prescription
12or refill. Except as provided in subdivision (g), “preferred drug”
13shall have the same meaning as in Section 1916A of the Social
14Security Act (42 U.S.C. Sec. 1396o-1).

15(5) Copayment of up to five dollars ($5) shall be made for each
16visit for services under subdivision (a) of Section 14132 and for
17dental services received on an outpatient basis provided as a
18Medi-Cal benefit pursuant to this chapter or Chapter 8
19(commencing with Section 14200), as applicable.

20(6) This section does not apply to services provided pursuant
21to subdivision (aa) of Section 14132.

22(d) The copayments established pursuant to subdivision (c) shall
23be set by the department, at the maximum amount provided for in
24the applicable paragraph, except that each copayment amount shall
25not exceed the maximum amount allowable pursuant to the state
26plan amendments or other federal approvals.

27(e) The copayment amounts set forth in subdivision (c) may be
28collected and retained or waived by the provider. The department
29shall deduct the amount of the copayment from the payment the
30department makes to the provider whether retained, waived, or not
31collected by the provider.

32(f) Notwithstanding any other provision of law, and only to the
33extent allowed pursuant to federal law, a provider of service has
34no obligation to provide services to a Medi-Cal beneficiary who
35does not, at the point of service, pay the copayment assessed
36pursuant to this section. If the provider provides services without
37collecting the copayment, and has not waived the copayment, the
38provider may hold the beneficiary liable for the copayment amount
39owed.

P109  1(g) (1) Notwithstanding any other provision of law, except as
2described in paragraph (2), this section shall apply to Medi-Cal
3beneficiaries enrolled in a health plan contracting with the
4department pursuant to this chapter or Chapter 8 (commencing
5with Section 14200), except for the Senior Care Action Network
6or AIDS Healthcare Foundation. To the extent permitted by federal
7law and pursuant to any federal waivers or state plan adjustments
8obtained, a managed care health plan may establish a lower
9copayment or no copayment.

10(2) For the purpose of paragraph (4) of subdivision (c),
11copayments assessed against a beneficiary who receives Medi-Cal
12services through a health plan described in paragraph (1) shall be
13based on the plan’s designation of a drug as preferred or
14nonpreferred.

15(3) To the extent provided by federal law, capitation payments
16shall be calculated on an actuarial basis as if copayments described
17in this section were collected.

18(h) This section shall not apply to any preventive services that
19are assigned a grade of A or B by the United States Preventive
20Services Task Force provided by a physician or other licensed
21practitioner of the healing arts, or any approved adult vaccines and
22their administration recommended by the Advisory Committee on
23Immunization Practices. Pursuant to Section 1905(b) of the federal
24Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
25be provided without any cost sharing by the beneficiary in order
26for the state to receive an increased federal medical assistance
27percentage for these services.

28(i) This section shall be implemented only to the extent that
29federal financial participation is available. The department shall
30seek and obtain any federal waivers or state plan amendments
31necessary to implement this section. The provisions for which
32appropriate federal waivers or state plan amendments cannot be
33obtained shall not be implemented, but provisions for which
34waivers or state plan amendments are either obtained or found to
35 be unnecessary shall be unaffected by the inability to obtain federal
36waivers or state plan amendments for the other provisions.

37(j) Notwithstanding Chapter 3.5 (commencing with Section
3811340) of Part 1 of Division 3 of Title 2 of the Government Code,
39the department may implement, interpret, or make specific this
40section by means of all-county letters, all-plan letters, provider
P110  1bulletins, or similar instructions, without taking further regulatory
2actions.

3(k) (1) This section shall become operative on the date that the
4act adding this section is effective, but shall not be implemented
5until the date in the declaration executed by the director pursuant
6to paragraph (2). In no event shall the director set an
7implementation date prior to the date federal approval is received.

8(2) The director shall execute a declaration that states the date
9that implementation of the copayments described in this section
10or subdivisions thereof, if applicable, will commence and shall
11post the declaration on the department’s Internet Web site and
12provide a copy of the declaration to the Chair of the Joint
13Legislative Budget Committee, the Chief Clerk of the Assembly,
14the Secretary of the Senate, the Office of the Legislative Counsel,
15and the Secretary of State.

16

SEC. 67.  

Section 14707.5 of the Welfare and Institutions Code
17 is amended to read:

18

14707.5.  

(a) It is the intent of the Legislature to develop a
19performance outcome system for Early and Periodic Screening,
20Diagnosis, and Treatment (EPSDT) mental health services that
21will improve outcomes at the individual and system levels and will
22inform fiscal decision making related to the purchase of services.

23(b) The State Department of Health Care Services, in
24collaboration with the California Health and Human Services
25Agency, and in consultation with the Mental Health Services
26Oversight and Accountability Commission, shall create a plan for
27a performance outcome system for EPSDT mental health services
28provided to eligible Medi-Cal beneficiaries under the age of 21
29pursuant to 42 U.S.C. Section 1396d(a)(4)(B).

30(1) Commencing no later than September 1, 2012, the
31department shall convene a stakeholder advisory committee
32comprised of representatives of child and youth clients, family
33members, providers, counties, and the Legislature. This
34consultation shall inform the creation of a plan for a performance
35outcome system for EPSDT mental health services.

36(2) In developing a plan for a performance outcomes system
37for EPSDT mental health services, the department shall consider
38the following objectives, among others:

39(A) High quality and accessible EPSDT mental health services
40for eligible children and youth, consistent with federal law.

P111  1(B) Information that improves practice at the individual,
2program, and system levels.

3(C) Minimization of costs by building upon existing resources
4to the fullest extent possible.

5(D) Reliable data that are collected and analyzed in a timely
6fashion.

7(3) At a minimum, the plan for a performance outcome system
8for EPSDT mental health services shall consider evidence-based
9models for performance outcome systems, such as the Child and
10Adolescent Needs and Strengths (CANS), federal requirements,
11including the review by the External Quality Review Organization
12(EQRO), and, timelines for implementation at the provider, county,
13and state levels.

14(c) The State Department of Health Care Services shall provide
15the performance outcomes system plan, including milestones and
16timelines, for EPSDT mental health services described in
17subdivision (a) to all fiscal committees and appropriate policy
18committees of the Legislature no later than October 1, 2013.

19(d) The State Department of Health Care Services shall propose
20how to implement the performance outcomes system plan for
21EPSDT mental health services described in subdivision (a) no later
22than January 10, 2014.

23(e) Commencing no later than February 1, 2014, the department
24shall convene a stakeholder advisory committee comprised of
25advocates for and representatives of, child and youth clients, family
26members, managed care health plans, providers, counties, and the
27Legislature. The committee shall develop methods to routinely
28measure, assess, and communicate program information regarding
29informing, identifying, screening, assessing, referring, and linking
30Medi-Cal eligible beneficiaries to mental health services and
31supports. The committee shall also review health plan screenings
32for mental health illness, health plan referrals to Medi-Cal
33fee-for-service providers, and health plan referrals to county mental
34health plans, among others. The committee shall make
35recommendations to the department regarding performance and
36outcome measures that will contribute to improving timely access
37to appropriate care for Medi-Cal eligible beneficiaries.

38(1) The department shall incorporate into the performance
39outcomes system established pursuant to this section the screenings
40and referrals described in this subdivision, including milestones
P112  1and timelines, and shall provide an updated performance outcomes
2system plan to all fiscal committees and the appropriate policy
3committees of the Legislature no later than October 1, 2014.

4(2) The department shall propose how to implement the updated
5performance systems outcome plan described in paragraph (1) no
6later than January 10, 2015.

7

SEC. 68.  

Part 3.3 (commencing with Section 15800) is added
8to Division 9 of the Welfare and Institutions Code, to read:

9 

10PART 3.3.  Health Care Coverage Assistance

11

 

12Chapter  1. General Provisions
13

 

14

15800.  

(a) (1) Commencing October 1, 2013, the State
15Department of Health Care Services shall administer the
16AIM-Linked Infants Program to address the health care needs of
17children formerly covered pursuant to clause (ii) of subparagraph
18(A) of paragraph (6) of subdivision (a) of Section 12693.70 of the
19Insurance Code. The department is vested with the same powers,
20purposes, responsibilities, and jurisdiction exercised by the
21Managed Risk Medical Insurance Board as they relate to those
22children. Nothing in this paragraph shall be construed to alter,
23diminish, or supersede the authority of the Managed Risk Medical
24Insurance Board to exercise the same powers, purposes,
25responsibilities, and jurisdiction within the Healthy Families
26Program established under Part 6.2 (commencing with Section
27 12693) of Division 2 of the Insurance Code.

28(2) The department may, before October 1, 2013, conduct
29transition activities necessary to ensure the efficient transfer of the
30program identified in subdivision (a) and populations served by
31that program.

32(b) The department shall seek any federal waivers, approvals,
33and state plan amendments necessary to implement this part. This
34part shall only be implemented to the extent that necessary federal
35approvals are obtained and federal financial participation is
36available for eligible programs and services.

37

15801.  

The terms of all regulations and orders adopted by the
38Managed Risk Medical Insurance Board in effect immediately
39preceding October 1, 2013, that relate to the operation of the
40program and to the children transferred by the act that added this
P113  1section and are not rendered legally unenforceable by the act that
2added this section shall be fully enforceable by the State
3Department of Health Care Services within the AIM-Linked Infants
4Program unless and until the department adopts regulations for
5the AIM-Linked Infants Program. Nothing in this section shall be
6construed to alter, diminish, or supersede the authority of the
7Managed Risk Medical Insurance Board to interpret, enforce,
8maintain, or amend the same regulations for purposes of the
9Healthy Families Program established under Part 6.2 (commencing
10with Section 12693) of Division 2 of the Insurance Code.

11

15802.  

(a) The State Department of Health Care Services may
12issue rules and regulations to carry out the purposes of this part.

13(b) Notwithstanding subdivision (a) or Chapter 3.5 (commencing
14with Section 11340) of Part 1 of Division 3 of Title 2 of the
15Government Code, the department, without taking any further
16regulatory actions, may implement, interpret, or make specific this
17part and amend or repeal regulations and orders adopted by the
18Managed Risk Medical Insurance Board as provided in Section
1915801 by means of all-county letters, plan letters, plan or provider
20bulletins, or similar instructions, without taking regulatory action
21during the transition of the programs to the department. Thereafter,
22the adoption and readoption of regulations to implement, interpret,
23or make specific this part shall be deemed to be an emergency that
24calls for immediate action to avoid serious harm to the public
25peace, health, safety, or general welfare for purposes of Sections
2611346.1 and 11349.6 of the Government Code, and the department
27is exempted from the requirement that it describe facts showing
28the need for immediate action. The regulations shall become
29effective immediately upon filing with the Secretary of State.

30

15803.  

(a) To implement this part and clause (ii) of
31subparagraph (A) of paragraph (6) of subdivision (a) of Section
3212693.70 of the Insurance Code, the State Department of Health
33Care Services may contract with public or private entities, including
34the Managed Risk Medical Insurance Board, which administers
35the Access for Infants and Mothers Program pursuant to Part 6.3
36(commencing with Section 12695) of Division 2 of the Insurance
37Code. Contracts entered into under this part may be on a
38noncompetitive bid basis and shall be exempt from the following:

P114  1(1) Part 2 (commencing with Section 10100) of Division 2 of
2the Public Contract Code and any policies, procedures, or
3regulations authorized by that part.

4(2) Article 4 (commencing with Section 19130) of Chapter 5
5of Part 2 of Division 5 of Title 2 of the Government Code.

6(3) Review or approval of contracts by the Department of
7General Services.

8(b) During the transition of the programs to the department, the
9department shall also be exempt from the review or approval of
10feasibility study reports and the requirements of Sections 4819.35
11to 4819.37, inclusive, and 4920 to 4928, inclusive, of the State
12Administrative Manual.

13

15804.  

On October 1, 2013, or when the State Department of
14Health Care Services has implemented Chapter 2 (commencing
15with Section 15850), whichever occurs later, the Managed Risk
16Medical Insurance Board shall cease to provide coverage to the
17children transferred to the AIM-Linked Infants Program, pursuant
18to Section 15800.

19

15805.  

(a) The Managed Risk Medical Insurance Board shall
20provide the State Department of Health Care Services any data,
21information, or record concerning the Healthy Families Program
22or the Access for Infants and Mothers Program as are necessary
23to implement this part and clause (ii) of subparagraph (A) of
24paragraph (6) of subdivision (a) of Section 12693.70 of the
25Insurance Code.

26(b) Notwithstanding any other law, all of the following shall
27apply:

28(1) The term “data, information, or record” shall include, but is
29not limited to, personal information as defined in Section 1798.3
30of the Civil Code.

31(2) Any data, information, or record shall be exempt from
32disclosure under the California Public Records Act (Chapter 3.5
33(commencing with Section 6250) of Division 7 of the Government
34Code) and any other law, to the same extent that it was exempt
35from disclosure or privileged prior to the provision of the data,
36information, or record to the department.

37(3) The provision of any data, information, or record to the
38department shall not constitute a waiver of any evidentiary
39privilege or exemption from disclosure.

P115  1(4) The department shall keep all data, information, or records
2provided by the Managed Risk Medical Insurance Board
3confidential to the full extent permitted by law, including, but not
4limited to, the California Public Records Act (Chapter 3.5
5(commencing with Section 6250) of Division 7 of the Government
6Code), and consistent with the Managed Risk Medical Insurance
7Board’s contractual obligations to keep data, information, or
8records confidential.

9 

10Chapter  2. AIM-Linked Infants Program
11

 

12

15810.  

This chapter shall be known, and may be cited, as the
13AIM-Linked Infants Program.

14

15811.  

The definitions contained in this section govern the
15construction of this chapter, unless the context requires otherwise.

16(a) “AIM-linked infant” means any infant born to a woman
17whose enrollment in the Access for Infants and Mothers Program
18under Part 6.3 (commencing with Section 12695) of Division 2 of
19the Insurance Code begins after June 30, 2004.

20(b) “Department” means the State Department of Health Care
21Services.

22(c) “Program” means the AIM-Linked Infants Program.

23(d) “Subscriber” means an individual who is eligible for and
24enrolled in the program.

25(e) “Subscriber contribution” means the cost to the subscriber
26to participate in the program.

27

15822.  

Health care services under the program shall include,
28but are not limited to, all of the following:

29(a) Preventive, screening, diagnostic, and treatment services
30furnished directly by a licensed clinic, either onsite or by formal
31written contract, on a case-managed basis, to patients who remain
32less than 24 hours at the clinic for an illness or injury, advice,
33counseling, outreach, and translation as needed.

34(b) Physician services.

35(c) Emergency first aid, perinatal, obstetric, radiology,
36laboratory, and nutrition services.

37(d) Services of advanced practice nurses or mid-level
38practitioners who are authorized to perform any of the services
39listed in this section within the scope of their licensure.

P116  1(e) All services and benefits set forth in Chapter 7 (commencing
2with Section 14000) of Part 3.

3

15824.  

To the extent permitted by federal law, services for
4individuals eligible under this chapter shall be provided, at the
5department’s discretion and to the extent the department determines
6the selected delivery system is cost effective, through the Medi-Cal
7fee-for-service or managed care delivery system, or both.

8

15826.  

The department shall administer the program and may
9do all of the following:

10(a) Determine eligibility criteria for the program. These criteria
11shall include the requirements set forth in Section 15832.

12(b) Determine the eligibility of AIM-linked infants.

13(c) Determine when subscribers are covered and the extent and
14scope of coverage.

15(d) Determine subscriber contribution amounts schedules.
16Subscriber contributions shall not be greater than those applicable
17on March 23, 2010, for infants enrolled pursuant to clause (ii) of
18subparagraph (A) of paragraph (6) of subdivision (a) of Section
1912693.70 of the Insurance Code.

20(e) Provide coverage through Medi-Cal delivery systems and
21contract for the administration of the program and the enrollment
22of subscribers. Any contract entered into pursuant to this chapter
23shall be exempt from any provision of law relating to competitive
24bidding, and shall be exempt from the review or approval of any
25division of the Department of General Services. The department
26shall not be required to specify the amounts encumbered for each
27contract, but may allocate funds to each contract based on projected
28and actual subscriber enrollments in a total amount not to exceed
29the amount appropriated for the program.

30(f) Authorize expenditures to pay program expenses that exceed
31subscriber contributions, and to administer the program as
32necessary.

33(g) Develop a promotional component of the program to make
34Californians aware of the program and the opportunity that it
35presents.

36(h) (1) Issue rules and regulations as necessary to administer
37the program.

38(2) During the 2011-12 to 2014-15 fiscal years, inclusive, the
39adoption and readoption of regulations pursuant to this chapter
40shall be deemed to be an emergency that calls for immediate action
P117  1to avoid serious harm to the public peace, health, safety, or general
2welfare for purposes of Sections 11346.1 and 11349.6 of the
3Government Code, and the department is hereby exempted from
4the requirement that the department describe facts showing the
5need for immediate action.

6(i) Exercise all powers reasonably necessary to carry out the
7powers and responsibilities expressly granted or imposed by this
8chapter.

9

15828.  

The department shall coordinate with other state
10agencies, as appropriate, to help ensure continuity of health care
11services.

12

15830.  

(a) The department may contract with a variety of
13health plans and types of health care service delivery systems in
14order to offer subscribers a choice of plans, providers, and types
15of service delivery.

16(b) Participating health plans contracting with the department
17pursuant to this chapter shall provide benefits or coverage to
18subscribers only as determined by the department pursuant to
19subdivision (b) of Section 15826.

20

15832.  

To be eligible to participate in the program, a person
21shall meet all of the following requirements:

22(a) (1) Be a child under two years of age who is delivered by
23a mother enrolled in the program under Part 6.3 (commencing with
24Section 12695) of Division 2 of the Insurance Code. Except as
25stated in this section, these infants shall be automatically enrolled
26in the program.

27(2) For the applicable month, not be enrolled in
28employer-sponsored health care coverage, or have been enrolled
29in that health care coverage in the prior three months or enrolled
30in full-scope Medi-Cal without a share of cost. Exceptions may
31be identified in regulations or other guidance and shall, at
32minimum, include all exceptions applicable to the Healthy Families
33Program on and after March 23, 2010.

34(3) Be subject to subscriber contributions as determined by the
35department. The subscriber contributions shall not be greater than
36those applicable on March 23, 2010, for infants enrolled in the
37Healthy Families Program pursuant to clause (ii) of subparagraph
38(A) of paragraph (6) of subdivision (a) of Section 12693.70 of the
39Insurance Code.

P118  1(b) For AIM-linked infants identified in subdivision (a), all of
2the following shall apply:

3(1) Enrollment shall cover the first 12 months of the infant’s
4life unless he or she is eligible for Medi-Cal benefits under Section
514005.26. If the infant is eligible under Section 14005.26, he or
6she shall be automatically enrolled in the Medi-Cal program on
7that basis.

8(2) (A) At the end of the 12 months, as a condition of continued
9eligibility, the subscriber shall provide income information. The
10infant shall be disenrolled from the program if the annual household
11income exceeds 300 percent of the federal poverty level, or if the
12infant is eligible for full-scope Medi-Cal with no share of cost.

13(B) Effective January 1, 2014, when determining eligibility for
14benefits under the program, income shall be determined, counted,
15and valued in accordance with the requirements of Section
161397bb(b)(1)(B) of Title 42 of the United States Code as added
17by the federal Patient Protection and Affordable Care Act (Public
18Law 111-148) and as amended by the federal Health Care and
19Education Reconciliation Act of 2010 (Public Law 111-152) and
20any subsequent amendments.

21(3) At the end of their first and second year in the program,
22infants shall be screened for eligibility for the Medi-Cal program.

23(c) If at any time the director determines that the eligibility
24criteria established under this chapter for the program may
25jeopardize the state’s ability to receive federal financial
26participation under the federal Patient Protection and Affordable
27Care Act (Public Law 111-148), or any amendment or extension
28of that act, the director may alter the eligibility criteria to the extent
29necessary for the state to receive that federal financial participation.

30

15834.  

A person shall not be eligible for covered services under
31the program if those services are covered through private health
32care coverage arrangements at the time of eligibility.

33

15836.  

(a) If a subscriber is dissatisfied with any action, or
34failure to act, that has occurred in connection with eligibility or
35covered services under this chapter, the subscriber may appeal to
36the department and shall be accorded an opportunity for a fair
37hearing. Hearings may be conducted pursuant to the provisions of
38Chapter 5 (commencing with Section 11500) of Part 1 of Division
393 of Title 2 of the Government Code.

P119  1(b) The department may place a lien on compensation or benefits
2that are recovered or recoverable by a subscriber for whom benefits
3have been provided under a policy or plan issued under this chapter
4from any party or parties responsible for the compensation or
5benefits.

6

15838.  

(a) A provider who is furnished documentation of a
7subscriber’s enrollment in the program shall not seek
8reimbursement or attempt to obtain payment for any covered
9services provided to that subscriber other than from the
10participating health plan or insurer covering the subscriber or from
11the department.

12(b) Subdivision (a) shall not apply to any copayment required
13by the department under this chapter for the covered services
14provided to the subscriber.

15(c) For purposes of this chapter, “provider” means any
16professional person, organization, health facility, or other person
17or institution licensed by the state to deliver or furnish health care
18services and includes as that term is defined in subdivision (o) of
19Section 14043.1.

20

15840.  

(a) At a minimum, coverage provided pursuant to this
21chapter shall be provided to eligible AIM-linked infants less than
22two years of age.

23(b) Coverage provided pursuant to this chapter shall include, at
24a minimum, those services required to be provided by health care
25service plans approved by the Secretary of Health and Human
26Services as a federally qualified health care service plan pursuant
27to Section 417.101 of Title 42 of the Code of Federal Regulations.

28(c) Medically necessary prescription drugs shall be a required
29benefit in the coverage provided pursuant to this chapter.

30

15842.  

Notwithstanding any other law, for a subscriber who
31is determined by the California Children’s Services Program to be
32eligible for benefits under the program pursuant to Article 5
33(commencing with Section 123800) of Chapter 3 of Part 2 of
34Division 106 of the Health and Safety Code, a provider shall not
35be responsible for the provision of, or payment for, the particular
36services authorized by the California Children’s Services Program
37for the particular subscriber for the treatment of a California
38Children’s Services Program eligible medical condition. Providers
39shall refer a child whom they reasonably suspect of having a
40medical condition that is eligible for services under the California
P120  1Children’s Services Program to the California Children’s Services
2Program. The California Children’s Services Program shall provide
3case management and authorization of services if the child is found
4to be medically eligible for the California Children’s Services
5Program. Diagnosis and treatment services that are authorized by
6the California Children’s Services Program shall be performed by
7paneled providers for that program and approved special care
8centers of that program in accordance with treatment plans
9approved by the California Children’s Services Program. All other
10services provided under this chapter shall be available to the
11subscriber.

12

15844.  

A child enrolled in the program under this chapter who
13has a medical condition that is eligible for services pursuant to the
14California Children’s Services Program, and whose family is not
15financially eligible for the California Children’s Services Program,
16shall have the medically necessary treatment services for his or
17her California Children’s Services Program eligible medical
18condition authorized and paid for by the California Children’s
19Services Program. County expenditures for the payment of services
20for the child shall be waived and these expenditures shall be paid
21for by the state from Title XXI of the federal Social Security Act
22(42 U.S.C. Sec. 1397aa et seq.) funds and state general funds.

23

15846.  

The department shall encourage all providers who
24provide services under the program to have viable protocols for
25screening and referring children needing supplemental services
26outside of the scope of the screening, preventive, and medically
27necessary and therapeutic services covered by the contract to public
28programs providing such supplemental services for which they
29may be eligible, as well as for coordination of care between the
30provider and the public programs. The public programs for which
31providers may be required to develop screening, referral, and care
32coordination protocols may include the California Children’s
33Services Program, the regional centers, county mental health
34programs, programs administered by the Department of Alcohol
35and Drug Programs or its successor agency or agencies, and
36programs administered by local education agencies.

37

SEC. 69.  

Section 15911 of the Welfare and Institutions Code
38 is amended to read:

39

15911.  

(a) Funding for each LIHP shall be based on all of the
40following:

P121  1(1) The amount of funding that the participating entity
2voluntarily provides for the nonfederal share of LIHP expenditures.

3(2) For a LIHP that had in operation a Health Care Coverage
4Initiative program under Part 3.5 (commencing with Section 15900)
5as of November 1, 2010, and elects to continue funding the
6program, the amount of funds requested to ensure that eligible
7enrollees continue to receive health care services for persons
8enrolled in the Health Care Coverage Initiative program as of
9November 1, 2010.

10(3) Any limitations imposed by the Special Terms and
11Conditions of the demonstration project.

12(4) The total allocations requested by participating entities for
13Health Care Coverage Initiative eligible individuals.

14(5) Whether funding under this part would result in the reduction
15of other payments under the demonstration project.

16(b) Nothing in this part shall be construed to require a political
17subdivision of the state to participate in a LIHP as set forth in this
18part, and those local funds expended or transferred for the
19nonfederal share of LIHP expenditures under this part shall be
20considered voluntary contributions for purposes of the federal
21Patient Protection and Affordable Care Act (Public Law 111-148),
22as amended by the federal Health Care and Education
23Reconciliation Act of 2010 (Public Law 111-152), and the federal
24American Recovery and Reinvestment Act of 2009 (Public Law
25111-5), as amended by the federal Patient Protection and
26Affordable Care Act.

27(c) No state General Fund moneys shall be used to fund LIHP
28services, nor to fund any related administrative costs incurred by
29counties or any other political subdivision of the state.

30(d) Subject to the Special Terms and Conditions of the
31demonstration project, if a participating entity elects to fund the
32nonfederal share of a LIHP, the nonfederal funding and payments
33to the LIHP shall be provided through one of the following
34mechanisms, at the options of the participating entity:

35(1) On a quarterly basis, the participating entity shall transfer
36to the department for deposit in the LIHP Fund established for the
37participating counties and pursuant to subparagraph (A), the
38amount necessary to meet the nonfederal share of estimated
39 payments to the LIHP for the next quarter under subdivision (g)
40Section 15910.3.

P122  1(A) The LIHP Fund is hereby created in the State Treasury.
2Notwithstanding Section 13340 of the Government Code, all
3moneys in the fund shall be continuously appropriated to the
4department for the purposes specified in this part. The fund shall
5contain all moneys deposited into the fund in accordance with this
6paragraph.

7(B) The department shall obtain the related federal financial
8participation and pay the rates established under Section 15910.3,
9provided that the intergovernmental transfer is transferred in
10accordance with the deadlines imposed under the Medi-Cal
11Checkwrite Schedule, no later than the next available warrant
12release date. This payment shall be a nondiscretionary obligation
13of the department, enforceable under a writ of mandate pursuant
14to Section 1085 of the Code of Civil Procedure. Participating
15entities may request expedited processing within seven business
16days of the transfer as made available by the Controller’s office,
17provided that the participating entity prepay the department for
18the additional administrative costs associated with the expedited
19processing.

20(C) Total quarterly payment amounts shall be determined in
21accordance with estimates of the number of enrollees in each rate
22category, subject to annual reconciliation to final enrollment data.

23(2) If a participating entity operates its LIHP through a contract
24with another entity, the participating entity may pay the operating
25entity based on the per enrollee rates established under Section
2615910.3 on a quarterly basis in accordance with estimates of the
27number of enrollees in each rate category, subject to annual
28reconciliation to final enrollment data.

29(A) (i) On a quarterly basis, the participating entity shall certify
30the expenditures made under this paragraph and submit the report
31of certified public expenditures to the department.

32(ii) The department shall report the certified public expenditures
33of a participating entity under this paragraph on the next available
34quarterly report as necessary to obtain federal financial
35participation for the expenditures. The total amount of federal
36financial participation associated with the participating entity’s
37expenditures under this paragraph shall be reimbursed to the
38participating entity.

39(B) At the option of the participating entity, the LIHP may be
40reimbursed on a cost basis in accordance with the methodology
P123  1applied to Health Care Coverage Initiative programs established
2under Part 3.5 (commencing with Section 15900) including interim
3quarterly payments.

4(e) Notwithstanding Section 15910.3 and subdivision (d) of this
5section, if the participating entity cannot reach an agreement with
6the department as to the appropriate rate to be paid under Section
715910.3, at the option of the participating entity, the LIHP shall
8be reimbursed on a cost basis in accordance with the methodology
9applied to Health Care Coverage Initiative programs established
10under Part 3.5 (commencing with Section 15900), including interim
11quarterly payments. If the participating entity and the department
12reach an agreement as to the appropriate rate, the rate shall be
13applied no earlier than the first day of the LIHP year in which the
14parties agree to the rate.

15(f) If authorized under the Special Terms and Conditions of the
16demonstration project, pending the department’s development of
17rates in accordance with Section 15910.3, the department shall
18make interim quarterly payments to approved LIHPs for
19expenditures based on estimated costs submitted for rate setting.

20(g) Participating entities that operate a LIHP directly or through
21contract with another entity shall be entitled to any federal financial
22participation available for administrative expenditures incurred in
23the operation of the Medi-Cal program or the demonstration
24project, including, but not limited to, outreach, screening and
25enrollment, program development, data collection, reporting and
26quality monitoring, and contract administration, but only to the
27extent that the expenditures are allowable under federal law and
28only to the extent the expenditures are not taken into account in
29the determination of the per enrollee rates under Section 15910.3.

30(h) On and after January 1, 2014, the state shall implement
31comprehensive health care reform for the populations targeted by
32the LIHP in compliance with federal health care reform law,
33regulation, and policy, including the federal Patient Protection and
34Affordable Care Act (Public Law 111-148), as amended by the
35federal Health Care and Education Reconciliation Act of 2010
36(Public Law 111-152), and subsequent amendments.

37(i) Subject to the Special Terms and Conditions of the
38demonstration project, a participating entity may elect to include,
39in collaboration with the department, as the nonfederal share of
40LIHP expenditures, voluntary intergovernmental transfers or
P124  1certified public expenditures of another governmental entity, as
2long as the intergovernmental transfer or certified public
3expenditure is consistent with federal law.

4(j) Participation in the LIHP under this part is voluntary on the
5part of the eligible entity for purposes of all applicable federal
6laws. As part of its voluntary participation under this article, the
7participating entity shall agree to reimburse the state for the
8nonfederal share of state staffing and administrative costs directly
9attributable to the cost of administering that LIHP, including, but
10not limited to, the state administrative costs related to certified
11public expenditures and intergovernmental transfers. This section
12shall be implemented only to the extent federal financial
13participation is not jeopardized.

14

SEC. 70.  

(a) The State Department of Health Care Services
15shall accept contributions by private foundations in the amount of
16at least fourteen million dollars ($14,000,000) for the purpose of
17this section and shall immediately seek an equal amount of federal
18matching funds.

19(b) Entities and persons that are eligible for Medi-Cal in-person
20enrollment assistance payments of fifty-eight dollars ($58) per
21approved Medi-Cal application and payment processing costs shall
22be those trained and eligible for in-person enrollment assistance
23payments by the California Health Benefit Exchange. The
24payments may be made by the State Department of Health Care
25Services or through the California Health Benefit Exchange
26in-person assistance payment system.

27(c) Enrollment assistance payments shall be made only for
28Medi-Cal applicants newly eligible for coverage pursuant to the
29federal Patient Protection and Affordable Care Act (Public Law
30111-148), as amended by the Health Care and Education
31Reconciliation Act of 2010 (Public Law 111-152), or those who
32have not been enrolled in the Medi-Cal program during the
33previous 12 months prior to making the application.

34(d) The commencement of enrollment assistance payments shall
35be consistent with those of the California Health Benefit Exchange.

36(e) The State Department of Health Care Services or the
37California Health Benefit Exchange shall provide monthly and
38cumulative payment updates and number of persons enrolled
39through in-person assistance payments on its Internet Web site.

P125  1

SEC. 71.  

(a) (1) The State Department of Health Care Services
2shall accept funding from private foundations in the amount of at
3least $12.5 million to provide allocations for the management and
4funding of Medi-Cal outreach and enrollment plans specific to the
5provisions contained in this section.

6(2) The department shall seek necessary federal approval for
7purposes of obtaining federal funding for activities conducted
8under this section.

9(3) Notwithstanding any other law, and in a manner that the
10Director of Health Care Services shall provide, the department
11may make allocations to fund Medi-Cal outreach and enrollment
12activities as described in this section.

13(b) (1) Funds appropriated by the Legislature to the department
14for the purposes of this section shall be made available to selected
15counties, counties acting jointly, and the County Medical Services
16Program Governing Board pursuant to Section 16809 of the
17Welfare and Institutions Code.

18(2) Selected counties, counties acting jointly, and the County
19Medical Services Program Governing Board may partner with
20community-based organizations as applicable to conduct outreach
21and enrollment to the target population as contained in subdivision
22(d).

23(3) The director may, at his or her discretion, also give
24consideration to community-based organizations in an area or
25region of the state if a county, or counties acting jointly do not
26seek an allocation or funds are made available.

27(4) For purposes of this section only, “county” shall be defined
28as county, city and county, a consortium of counties serving a
29region consisting of more than one county, the County Medical
30Services Program Governing Board, or a health authority.

31(c) (1) The allocations shall be apportioned geographically, by
32the entities identified in subdivision (b), according to the estimated
33number of persons who are eligible but not enrolled in Medi-Cal
34and who will be newly Medi-Cal eligible as of January 1, 2014.

35(2) The department may determine the number of allocations
36and the application process. The director may consult or obtain
37technical assistance from private foundations in implementation
38of the application and allocation process.

39(3) The department shall coordinate and partner with the
40California Health Benefit Exchange on certified application assister
P126  1and outreach, enrollment, and marketing activities related to the
2federal Patient Protection and Affordable Care Act.

3(d) Notwithstanding any other law, the department shall develop
4selection criteria to allocate funds for the Medi-Cal outreach and
5enrollment activities with special emphasis targeting all of the
6following populations:

7(1) Persons with mental health disorder needs.

8(2) Persons with substance use disorder needs.

9(3) Persons who are homeless.

10(4) Young men of color.

11(5) Persons who are in county jail, in state prison, on state
12parole, on county probation, or under postrelease community
13supervision.

14(6) Families of mixed-immigration status.

15(7) Persons with limited English proficiency.

16(e) (1) The funds allocated under this section shall be used only
17for the Medi-Cal outreach and enrollment activities and may
18supplement, but shall not supplant, existing local, state, and
19foundation funding of county outreach and enrollment activities.

20(2) Notwithstanding Section 10744 of the Welfare and
21Institutions Code, the department may recoup or withhold all or
22part of an allocation for failure to comply with any requirements
23 or standards set forth by the department for the purposes of this
24section.

25(f) The department shall begin the payment for the outreach and
26enrollment allocation program no later than February 1, 2014.

27(g) Under the terms of the approved allocation for the outreach
28and enrollment program, funded entities under this section shall
29not receive payment for in-person assister payments for assisting
30potential Medi-Cal enrollees.

31(h) The department shall require progress reports, in a manner
32as determined by the department, from those receiving allocations
33under this section.

34(i) To the extent federal funding is received for the services
35specified in this section, reimbursements for costs incurred under
36the approved allocations shall be made in compliance with federal
37law.

38(j) Notwithstanding Chapter 3.5 (commencing with Section
3911340) of Part 1 of Division 3 of Title 2 of the Government Code,
40the department may implement, interpret, or make specific this
P127  1section by means of all-county letters, provider bulletins, or similar
2instructions.

3(k) The department may use a portion of the private foundation
4funding pursuant to paragraph (a) to carry out the activities under
5this section.

6

SEC. 72.  

Commencing no later than August 1, 2013, the State
7Department of Health Care Services shall convene a series of
8stakeholder meetings to receive input from clients, family members,
9providers, counties, and representatives of the Legislature
10concerning the development of the Behavioral Health Services
11Plan, as required by paragraph 25.d of the Special Terms and
12Conditions of California’s Bridge to Reform Section 1115(a)
13Medicaid Demonstration.

14

SEC. 73.  

Given the uncertainty within which persons diagnosed
15with HIV/AIDS from federal Ryan White HIV/AIDS Treatment
16Extension Act of 2009 funded programs may transition to Medi-Cal
17or other health insurance coverage, the State Department of Public
18Health shall report to the Joint Legislative Budget Committee by
19October 1, 2013, on whether any of the projections or assumptions
20used to develop the AIDS Drug Assistance Program (ADAP)
21estimated budget for the Budget Act of 2013 may result in an
22inability of ADAP to provide services to ADAP eligible clients.
23If the State Department of Public Health determines, before
24October 1, 2013, that ADAP is unable to provide services to ADAP
25eligible clients, the State Department of Public Health shall provide
26notification to the Joint Legislative Budget Committee within 15
27calendar days of making this determination.

28

SEC. 74.  

By October 1, 2013, the State Department of Public
29Health shall submit to the fiscal and appropriate policy committees
30of the Legislature a report describing how it plans to address the
31findings and recommendations described in its “Zero-Based
32Budgeting Review” report dated May 14, 2013, regarding the
33Infant Botulism Treatment and Prevention Program (BabyBIG
34program).

35

SEC. 75.  

As part of the Governor’s annual budget release to
36the Legislature in January and May, the State Department of Health
37Care Services shall identify as a separate policy change within the
38Medi-Cal Local Assistance Estimate, the projected General Fund
39savings attributable to the receipt of enhanced federal funding for
40Medi-Cal eligibles, subject to the use of Modified Adjusted Gross
P128  1Income as the basis for their income eligibility, who were
2previously calculated as being currently eligible and for whom the
3state received only a 50 percent federal matching assistant payment.
4The identified savings shall be attributed to the receipt of enhanced
5federal funding under Title XIX of the federal Social Security Act.
6The State Department of Health Care Services shall confer with
7applicable fiscal and policy staff of the Legislature by no later than
8October 1, 2013, regarding the potential content and attributes of
9the information provided in this policy change. This separate policy
10change format shall be provided through 2019-20.

11

SEC. 76.  

Notwithstanding any other law, the balance of Item
124150-001-0890 of the Budget Act of 2012 is reappropriated to the
13Department of Managed Health Care for the purposes of continuing
14operation of consumer assistance programs to help uninsured
15individuals obtain health care coverage pursuant to the terms of
16the federal Consumer Assistance Program Grant. These funds shall
17be available for encumbrance and expenditure until June 30, 2014.

18

SEC. 77.  

The adoption and readoption of regulations
19implementing portions of this act by the Managed Risk Medical
20Insurance Board shall be deemed an emergency and necessary to
21avoid serious harm to the public peace, health, safety, or general
22welfare for purposes of Sections 11346.1 and 11349.6 of the
23Government Code, and the board is hereby exempted from the
24requirement that it describe facts showing the need for immediate
25action and from review by the Office of Administrative Law.

26

SEC. 78.  

The Legislature finds and declares that Section 2 of
27this act, which amends Section 6254 to the Government Code, and
28Section 68 of this act, which adds Part 3.3 (commencing with
29Section 15800) to Division 9 of the Welfare and Institution Code,
30impose a limitation on the public’s right of access to the meetings
31of public bodies or the writings of public officials and agencies
32within the meaning of Section 3 of Article I of the California
33Constitution. Pursuant to that constitutional provision, the
34Legislature makes the following findings to demonstrate the interest
35protected by this limitation and the need for protecting that interest:

36(a) In order to ensure that the State Department of Health Care
37Services is not constrained in exercising its fiduciary powers and
38obligations to negotiate on behalf of the public as it implements
39the provisions of Part 3.3 (commencing with Section 15800) of
40Division 9 of the Welfare and Institutions Code, the limitations
P129  1on the public’s right of access imposed by Section 2 of this act are
2necessary.

3(b) To ensure the continued confidentiality of otherwise
4privileged or confidential information, the limitations on the
5public’s right of access imposed by Section 68 of this act are
6necessary.

7

SEC. 79.  

This act is a bill providing for appropriations related
8to the Budget Bill within the meaning of subdivision (e) of Section
912 of Article IV of the California Constitution, has been identified
10as related to the budget in the Budget Bill, and shall take effect
11immediately.



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